Skip to main content
SpringerLink
Log in

Donor-Site Morbidity after Anterior Cruciate Ligament Reconstruction Using Autografts

Clinical, Radiographic, Histological, and Ultrastructural Aspects

  • Chapter
Anterior Knee Pain and Patellar Instability

  • 1452 Accesses

Abstract

Postoperative donor-site morbidity and anterior knee pain following ACL surgery may result in substantial impairment for the patient. The selection of graft, surgical technique and rehabilitation program can affect the occurrence of undesirable pain conditions.

The loss or disturbance of anterior sensitivity caused by intraoperative injury to the infrapatellar nerve(s) in conjunction with patellar tendon harvest is correlated with donor-site discomfort and an inability to kneel and knee walk.

The patellar tendon at the donor site displays significant clinical, radiographic, histological, and ultrastructural abnormalities several years after harvesting its central third. The donor-site discomfort correlates poorly with radiographic and histological findings after the use of patellar tendon autografts. The use of hamstring tendon autografts causes less postoperative donor-site morbidity and anterior knee problems than the use of patellar tendon autografts. There also appears to be a regrowth of the hamstring tendons within two years after the harvesting procedure. There is a lack of knowledge in terms of the course of the donor site after harvesting fascia lata autografts. Harvesting quadriceps tendon autografts appears to cause low donor-site morbidity.

Efforts should be made to spare the infrapatellar nerve(s) during ACL reconstruction using patellar tendon autografts as well as hamstring autografts. Reharvesting the patellar tendon cannot be recommended due to significant clinical, radiographic, histological, and ultrastructural abnormalities several years after harvesting its central third. It is important to regain full range of motion and strength after the use of any type of autograft to avoid future anterior knee pain problems.

Since randomized controlled trials have shown that the laxity measurements and clinical results following ACL reconstruction using hamstring tendon autografts are similar to those of patellar tendon autografts, we recommend the use of hamstring tendon autografts due to fewer donor-site problems.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 199.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bach, BR, Jr., GT Jones, FA Sweet, and CA Hager. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution: Two-to four-year follow-up results. Am J Sports Med 1994; 22: 758–767.

    PubMed  Google Scholar 

  2. Bach, BR, Jr., GT Jones, CA Hager, FA Sweet, and S Luergans. Arthrometric results of arthroscopically assisted anterior cruciate ligament reconstruction using autograft patellar tendon substitution. Am J Sports Med 1995; 23: 179–185.

    PubMed  Google Scholar 

  3. Buss, DD, RF Warren, TL Wickiewicz, BJ Galinat, and R Panariello. Arthroscopically assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-ligament grafts: Results after twenty-four to forty-two months. J Bone Joint Surg [Am] 1993; 75: 1346–1355.

    CAS  PubMed  Google Scholar 

  4. Breitfuss, H, R Fröhlich, P Povacz, H Resch, and A Wicker. The tendon defect after anterior cruciate ligament reconstruction using the midthird patellar tendon-a problem for the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 1996; 3: 194–198.

    Article  CAS  PubMed  Google Scholar 

  5. Graf, B, and F Uhr. Complications of intra-articular anterior cruciate reconstruction. Clin Sports Med 1988; 7: 835–848.

    CAS  PubMed  Google Scholar 

  6. Kartus, J, S Stener, K Köhler, N Sernert, BI Eriksson, and J Karlsson. Is bracing after anterior cruciate ligament reconstruction necessary? A 2-year follow-up of 78 consecutive patients rehabilitated with or without a brace. Knee Surg Sports Traumatol Arthrosc 1997; 5: 157–161.

    CAS  PubMed  Google Scholar 

  7. Kohn, D, and A Sander-Beuermann. Donor-site morbidity after harvest of a bone-tendon-bone patellar tendon autograft. Knee Surg Sports Traumatol Arthrosc 1994; 2: 219–223.

    Article  CAS  PubMed  Google Scholar 

  8. Mohtadi, NG, S Webster-Bogaert, and PJ Fowler. Limitation of motion following anterior cruciate ligament reconstruction: A case-control study. Am J Sports Med 1991; 19: 620–625.

    CAS  PubMed  Google Scholar 

  9. Paulos, LE, TD Rosenberg, J Drawbert, J Manning, and P Abbott. Infrapatellar contracture syndrome: An unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 1987; 15: 331–341.

    CAS  PubMed  Google Scholar 

  10. Sachs, RA, DM Daniel, ML Stone, and RF Garfein. Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 1989; 17: 760–765.

    CAS  PubMed  Google Scholar 

  11. Shelbourne, KD, and RV Trumper. Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 1997; 25: 41–47.

    CAS  PubMed  Google Scholar 

  12. Dandy, DJ, JP Flanagan, and V Steenmeyer. Arthroscopy and the management of the ruptured anterior cruciate ligament. Clin Orthop 1982; 167: 43–49.

    PubMed  Google Scholar 

  13. Engström, B, T Wredmark, and P Westblad. Patellar tendon or Leeds-Keio graft in the surgical treatment of anterior cruciate ligament ruptures: Intermediate results. Clin Orthop 1993; 295: 190–197.

    PubMed  Google Scholar 

  14. Jackson, DW, ES Grood, JD Goldstein, MA Rosen, PR Kurzweil, JF Cummings, and TM Simon. A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 1993; 21: 176–185.

    CAS  PubMed  Google Scholar 

  15. Noyes, FR, and SD Barber-Westin. Reconstruction of the anterior cruciate ligament with human allograft: Comparison of early and later results. J Bone Joint Surg [Am] 1996; 78: 524–537.

    CAS  PubMed  Google Scholar 

  16. Nicholas, JA, and J Minkoff. Iliotibial band transfer through the intercondylar notch for combined anterior instability (ITPT procedure). Am J Sports Med 1978; 6: 341–353.

    CAS  PubMed  Google Scholar 

  17. Ekstrand, J. Reconstruction of the anterior cruciate ligament in athletes, using a fascia lata graft: A review with preliminary results of a new concept. Int J Sports Med 1989; 10: 225–232.

    CAS  PubMed  Google Scholar 

  18. Bak, K, U Jörgensen, J Ekstrand, and M Scavenius. Results of reconstruction of acute ruptures of the anterior cruciate ligament with an iliotibial band autograft. Knee Surg Sports Traumatol Arthrosc 1999; 7: 111–117.

    Article  CAS  PubMed  Google Scholar 

  19. Natri, A, M Järvinen, and P Kannus. Primary repair plus intra-articular iliotibial band augmentation in the treatment of an acute anterior cruciate ligament rupture: A follow-up study of 70 patients. Arch Orthop Trauma Surg 1996; 115: 22–27.

    Article  CAS  PubMed  Google Scholar 

  20. Laupattarakasem, W, and B Mahaisavariya. Iliotibial band for anterior cruciate ligament reconstruction: A new technique for graft augmentation, placement and fixation. J Med Assoc Thai 1994; 77: 343–350.

    CAS  PubMed  Google Scholar 

  21. Aglietti, P, R Buzzi, PM Menchetti, and F Giron. Arthroscopically assisted semitendinosus and gracilis tendon graft in reconstruction for acute anterior cruciate ligament injuries in athletes. Am J Sports Med 1996; 24: 726–731.

    CAS  PubMed  Google Scholar 

  22. Puddu, G. Method for reconstruction of the anterior cruciate ligament using the semitendinosus tendon. Am J Sports Med 1980; 8: 402–404.

    CAS  PubMed  Google Scholar 

  23. Otero, AL, and L Hutcheson. A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 1993; 9: 143–148.

    CAS  PubMed  Google Scholar 

  24. Siegel, MG, and SD Barber-Westin. Arthroscopic-assisted outpatient anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons. Arthroscopy 1998; 14: 268–277.

    CAS  PubMed  Google Scholar 

  25. Brown, CH, Jr., ME Steiner, and EW Carson. The use of hamstring tendons for anterior cruciate ligament reconstruction: Technique and results. Clin Sports Med 1993; 12: 723–756.

    PubMed  Google Scholar 

  26. Hamner, DL, CH Brown, Jr., ME Steiner, AT Hecker, and WC Hayes. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg [Am] 1999; 81: 549–557.

    CAS  PubMed  Google Scholar 

  27. Alm, A, and J Gillquist. Reconstruction of the anterior cruciate ligament by using the medial third of the patellar ligament: Treatment and results. Acta Chir Scand 1974; 140: 289–296.

    CAS  PubMed  Google Scholar 

  28. Clancy, WG, Jr., DA Nelson, B Reider, and RG Narechania. Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. J Bone Joint Surg [Am] 1982; 64: 352–359.

    PubMed  Google Scholar 

  29. Eriksson, E. Reconstruction of the anterior cruciate ligament. Orthop Clin North Am 1976; 7: 167–179.

    CAS  PubMed  Google Scholar 

  30. Jones, KG. Reconstruction of the anterior cruciate ligament. J Bone Joint Surg [Am] 1963; 45: 925–932.

    CAS  PubMed  Google Scholar 

  31. Jones, KG. Reconstruction of the anterior cruciate ligament using the central one-third of the patellar ligament. J Bone Joint Surg [Am] 1970; 52: 838–839.

    CAS  PubMed  Google Scholar 

  32. Marshall, JL, RF Warren, TL Wickiewicz, and B Reider. The anterior cruciate ligament: A technique of repair and reconstruction. Clin Orthop 1979; 143: 97–106.

    PubMed  Google Scholar 

  33. Chen, CH, WJ Chen, and CH Shih. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. J Trauma 1999; 46: 678–682.

    CAS  PubMed  Google Scholar 

  34. Fulkerson, JP, and R Langeland. An alternative cruciate reconstruction graft: The central quadriceps tendon. Arthroscopy 1995; 11: 252–254.

    CAS  PubMed  Google Scholar 

  35. Lee, S, SC Seong, H Jo, YK Park, and MC Lee. Outcome of anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthroscopy 2004; 20: 795–802.

    PubMed  Google Scholar 

  36. Noronha, JC. Reconstruction of the anterior cruciate ligament with quadriceps tendon. Arthroscopy 2002; 18: E37.

    PubMed  Google Scholar 

  37. Irrgang, JJ, and CD Harner. Loss of motion following knee ligament reconstruction. Sports Med 1995; 19: 150–159.

    CAS  PubMed  Google Scholar 

  38. Harner, CD, JJ Irrgang, J Paul, S Dearwater, and FH Fu. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20: 499–506.

    CAS  PubMed  Google Scholar 

  39. Kartus, J, L Magnusson, S Stener, S Brandsson, BI Eriksson, and J Karlsson. Complications following arthroscopic anterior cruciate ligament reconstruction: A 2-to 5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 1999; 7: 2–8.

    CAS  PubMed  Google Scholar 

  40. Stapleton, TR. Complications in anterior cruciate ligament reconstructions with patellar tendon grafts. Sports Med Arthrosc Rev 1997; 5: 156–162.

    Google Scholar 

  41. Aglietti, P, R Buzzi, S D’Andria, G Zaccherotti. Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction. Clin Orthop 1993; 288: 195–204.

    PubMed  Google Scholar 

  42. Risberg, MA, I Holm, H Steen, BD Beynnon. Sensitivity to changes over time for the IKDC form, the Lysholm score, and the Cincinnati knee score: A prospective study of 120 ACL reconstructed patients with a 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 1999; 7: 152–159.

    CAS  PubMed  Google Scholar 

  43. Muneta, T, I Sekiya, T Ogiuchi, K Yagishita, H Yamamoto, and K Shinomiya. Objective factors affecting overall subjective evaluation of recovery after anterior cruciate ligament reconstruction. Scand J Med Sci Sports 1998; 8: 283–289.

    CAS  PubMed  Google Scholar 

  44. Hiemstra, LA, S Webber, PB MacDonald, and DJ Kriellaars. Knee strength deficits after hamstring tendon and patellar tendon anterior cruciate ligament reconstruction. Med Sci Sports Exerc 2000; 32: 1472–1479.

    CAS  PubMed  Google Scholar 

  45. Feller, JA, and KE Webster. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 2003; 31: 564–573.

    PubMed  Google Scholar 

  46. Adachi, N, M Ochi, Y Uchio, Y Sakai, M Kuriwaka, and A Fujihara. Harvesting hamstring tendons for ACL reconstruction influences postoperative hamstring muscle performance. Arch Orthop Trauma Surg 2003; 123: 460–465.

    Article  PubMed  Google Scholar 

  47. Tashiro, T, H Kurosawa, A Kawakami, A Hikita, and N Fukui. Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction: A detailed evaluation with comparison of single-and double-tendon harvest. Am J Sports Med 2003; 31: 522–529.

    PubMed  Google Scholar 

  48. Arthornthurasook, A, and K Gaew-Im. Study of the infrapatellar nerve. Am J Sports Med 1988; 16: 57–59.

    CAS  PubMed  Google Scholar 

  49. Horner, G, and AL Dellon. Innervation of the human knee joint and implications for surgery. Clin Orthop 1994; 301: 221–226.

    PubMed  Google Scholar 

  50. Hunter, LY, DS Louis, JR Ricciardi, and GA O’Connor. The saphenous nerve: Its course and importance in medial arthrotomy. Am J Sports Med 1979; 7: 227–230.

    CAS  PubMed  Google Scholar 

  51. Kartus, J, L Ejerhed, BI Eriksson, and J Karlsson. The localization of the infrapatellar nerves in the anterior knee region with special emphasis on central third patellar tendon harvest: A dissection study on cadaver and amputated specimens. Arthroscopy 1999; 15: 577–586.

    CAS  PubMed  Google Scholar 

  52. Abbott, LC, and WF Carpenter. Surgical approaches to the knee joint. J Bone Joint Surg [Am] 1945; 27: 277–310.

    Google Scholar 

  53. Kennedy, JC, IJ Alexander, and KC Hayes. Nerve supply of the human knee and its functional importance. Am J Sports Med 1982; 10: 329–335.

    CAS  PubMed  Google Scholar 

  54. von Lantz, T, and W Wachmuth. Praktische Anatomie. Berlin: Springer-Verlag, 1972.

    Google Scholar 

  55. Boon, JM, MJ Van Wyk, and D Jordaan. A safe area and angle for harvesting autogenous tendons for anterior cruciate ligament reconstruction. Surg Radiol Anat 2004; 26: 167–171.

    CAS  PubMed  Google Scholar 

  56. Johnson, RJ, DB Kettelkamp, W Clark, and P Leaverton. Factors effecting late results after meniscectomy. J Bone Joint Surg [Am] 1974; 56: 719–729.

    CAS  PubMed  Google Scholar 

  57. Swanson, AJ. The incidence of prepatellar neuropathy following medial meniscectomy. Clin Orthop 1983; 181: 151–153.

    PubMed  Google Scholar 

  58. Tapper, EM, and NW Hoover. Late results after meniscectomy. J Bone Joint Surg [Am] 1969; 51: 517–526.

    CAS  PubMed  Google Scholar 

  59. Chambers, GH. The prepatellar nerve: A cause of suboptimal results in knee arthrotomy. Clin Orthop 1972; 82: 157–159.

    CAS  PubMed  Google Scholar 

  60. Ganzoni, N, and K Wieland. The ramus infrapatellaris of the saphenous nerve and its importance for medial parapatellar arthrotomies of the knee. Reconstr Surg Traumatol 1978; 16: 95–100.

    CAS  PubMed  Google Scholar 

  61. Mochida, H, and S Kikuchi. Injury to infrapatellar branch of saphenous nerve in arthroscopic knee surgery. Clin Orthop 1995; 320: 88–94.

    PubMed  Google Scholar 

  62. Poehling, GG, FE Pollock, Jr., and LA Koman. Reflex sympathetic dystrophy of the knee after sensory nerve injury. Arthroscopy 1988; 4: 31–35.

    CAS  PubMed  Google Scholar 

  63. Gordon, GC. Traumatic prepatellar neuralgia. J Bone Joint Surg [Br] 1952; 34: 41–44.

    Google Scholar 

  64. Detenbeck, LC. Infrapatellar traumatic neuroma resulting from dashboard injury. J Bone Joint Surg [Am] 1972; 54: 170–172.

    CAS  PubMed  Google Scholar 

  65. House, JH, and K Ahmed. Entrapment neuropathy of the infrapatellar branch of the saphenous nerve. Am J Sports Med 1977; 5: 217–224.

    CAS  PubMed  Google Scholar 

  66. Worth, RM, DB Kettelkamp, RJ Defalque, and KU Duane. Saphenous nerve entrapment: A cause of medial knee pain. Am J Sports Med 1984; 12: 80–81.

    CAS  PubMed  Google Scholar 

  67. Slocum, DB, and RL Larson. Pes anserinus transplantation: A surgical procedure for control of rotatory instability of the knee. J Bone Joint Surg [Am] 1968; 50: 226–242.

    CAS  PubMed  Google Scholar 

  68. Berg, P, and B Mjöberg. A lateral skin incision reduces peripatellar dysaesthesia after knee surgery. J Bone Joint Surg [Br] 1991; 73: 374–376.

    CAS  Google Scholar 

  69. Kartus, J, S Stener, S Lindahl, B Engström, BI Eriksson, and J Karlsson. Factors affecting donor-site morbidity after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. Knee Surg Sports Traumatol Arthrosc 1997; 5: 222–228.

    CAS  PubMed  Google Scholar 

  70. Mastrokalos, DS, J Springer, R Siebold, and HH Paessler. Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft: A retrospective, nonrandomized study. Am J Sports Med 2005; 33: 85–93.

    PubMed  Google Scholar 

  71. Mishra, AK, GS Fanton, MF Dillingham, and TJ Carver. Patellar tendon graft harvesting using horizontal incisions for anterior cruciate ligament reconstruction. Arthroscopy 1995; 11: 749–752.

    CAS  PubMed  Google Scholar 

  72. Karlsson, J, J Kartus, S Brandsson, L Magnusson, O Lundin, and BI Eriksson. Comparison of arthroscopic one-incision and two-incision techniques for reconstruction of the anterior cruciate ligament. Scand J Med Sci Sports 1999; 9: 233–238.

    CAS  PubMed  Google Scholar 

  73. Kartus, J, L Ejerhed, N Sernert, S Brandsson, and J Karlsson. Comparison of traditional and subcutaneous patellar tendon harvest: A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques. Am J Sports Med 2000; 28: 328–335.

    CAS  PubMed  Google Scholar 

  74. Kartus, J, S Lindahl, S Stener, BI Eriksson, and J Karlsson. Magnetic resonance imaging of the patellar tendon after harvesting its central third: A comparison between traditional and subcutaneous harvesting techniques. Arthroscopy 1999; 15: 587–593.

    CAS  PubMed  Google Scholar 

  75. Tsuda, E, Y Okamura, Y Ishibashi, H Otsuka, and S Toh. Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Am J Sports Med 2001; 29: 450–456.

    CAS  PubMed  Google Scholar 

  76. Tifford, CD, L Spero, T Luke, and KD Plancher. The relationship of the infrapatellar branches of the saphenous nerve to arthroscopy portals and incisions for anterior cruciate ligament surgery: An anatomic study. Am J Sports Med 2000; 28: 562–567.

    CAS  PubMed  Google Scholar 

  77. Bertram, C, M Porsch, MH Hackenbroch, and D Terhaag. Saphenous neuralgia after arthroscopically assisted anterior cruciate ligament reconstruction with a semitendinosus and gracilis tendon graft. Arthroscopy 2000; 16: 763–766.

    CAS  PubMed  Google Scholar 

  78. Eriksson, K. On the semitendinosus in anterior cruciate ligament reconstructive surgery. Thesis 2001; Karolinska Institutet.

    Google Scholar 

  79. Ejerhed, L, J Kartus, N Sernert, K Köhler, and J Karlsson. Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 2003; 31: 19–25.

    PubMed  Google Scholar 

  80. Spicer, DD, SE Blagg, AJ Unwin, and RL Allum. Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2000; 8: 286–289.

    Article  CAS  PubMed  Google Scholar 

  81. Brandsson, S, E Faxén, BI Eriksson, P Kälebo, L Swärd, O Lundin, and J Karlsson. Closing patellar tendon defects after anterior cruciate ligament reconstruction: absence of any benefit. Knee Surg Sports Traumatol Arthrosc 1998; 6: 82–87.

    Article  CAS  PubMed  Google Scholar 

  82. Boszotta, H, and K Prunner. Refilling of removal defects: Impact on extensor mechanism complaints after use of a bone-tendon-bone graft for anterior cruciate ligament reconstruction. Arthroscopy 2000; 16: 160–164.

    CAS  PubMed  Google Scholar 

  83. Rubinstein, RA, Jr., KD Shelbourne, CD VanMeter, JC McCarroll, and AC Rettig. Isolated autogenous bone-patellar tendon-bone graft site morbidity. Am J Sports Med 1994; 22: 324–327.

    PubMed  Google Scholar 

  84. Corry, IS, JM Webb, AJ Clingeleffer, and LA Pinczewski. Arthroscopic reconstruction of the anterior cruciate ligament: A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 1999; 27: 444–454.

    CAS  PubMed  Google Scholar 

  85. Yasuda, K, J Tsujino, Y Ohkoshi, Y Tanabe, and K Kaneda. Graft site morbidity with autogenous semitendinosus and gracilis tendons. Am J Sports Med 1995; 23: 706–714.

    CAS  PubMed  Google Scholar 

  86. Eriksson, K, P Anderberg, P Hamberg, AC Löfgren, M Bredenberg, I Westman, and T Wredmark. A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg [Br] 2001; 83: 348–354.

    Article  CAS  Google Scholar 

  87. Eriksson, K, P Anderberg, P Hamberg, P Olerud, and T Wredmark. There are differences in early morbidity after ACL reconstruction when comparing patellar tendon and semitendinosus tendon graft: A prospective randomized study of 107 patients. Scand J Med Sci Sports 2001; 11: 170–177.

    CAS  PubMed  Google Scholar 

  88. Theut, PC, JP Fulkerson, EF Armour, and M Joseph. Anterior cruciate ligament reconstruction utilizing central quadriceps free tendon. Orthop Clin North Am 2003; 34: 31–39.

    Article  PubMed  Google Scholar 

  89. Santori, N, E Adriani, and L Pederzini. ACL reconstruction using quadriceps tendon. Orthopedics 2004; 27: 31–35.

    PubMed  Google Scholar 

  90. Coupens, SD, CK Yates, C Sheldon, and C Ward. Magnetic resonance imaging evaluation of the patellar tendon after use of its central one-third for anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20: 332–335.

    CAS  PubMed  Google Scholar 

  91. Berg, EE. Intrinsic healing of a patellar tendon donor site defect after anterior cruciate ligament reconstruction. Clin Orthop 1992; 278: 160–163.

    PubMed  Google Scholar 

  92. Nixon, RG, GK SeGall, SL Sax, TE Cain, and HS Tullos. Reconstitution of the patellar tendon donor site after graft harvest. Clin Orthop 1995; 317: 162–171.

    PubMed  Google Scholar 

  93. Liu, SH, DW Hang, A Gentili, and GA Finerman. MRI and morphology of the insertion of the patellar tendon after graft harvesting. J Bone Joint Surg [Br] 1996; 78: 823–826.

    CAS  Google Scholar 

  94. Meisterling, RC, T Wadsworth, R Ardill, H Griffiths, and CL Lane-Larsen. Morphologic changes in the human patellar tendon after bone-tendon-bone anterior cruciate ligament reconstruction. Clin Orthop 1993; 289: 208–212.

    PubMed  Google Scholar 

  95. Kartus, J, S Stener, S Lindahl, BI Eriksson, and J Karlsson. Ipsi-or contralateral patellar tendon graft in anterior cruciate ligament revision surgery: A comparison of two methods. Am J Sports Med 1998; 26: 499–504.

    CAS  PubMed  Google Scholar 

  96. Svensson, M, J Kartus, L Ejerhed, S Lindahl, and J Karlsson. Does the patellar tendon normalize after harvesting its central third? A prospective long-term MRI study. Am J Sports Med 2004; 32: 34–38.

    PubMed  Google Scholar 

  97. Wiley, JP, RC Bray, DA Wiseman, PD Elliott, KO Ladly, and LA Vale. Serial ultrasonographic imaging evaluation of the patellar tendon after harvesting its central one third for anterior cruciate ligament reconstruction. J Ultrasound Med 1997; 16: 251–255.

    CAS  PubMed  Google Scholar 

  98. Kartus, J, T Movin, N Papadogiannakis, LR Christensen, S Lindahl, and J Karlsson. A radiographic and histologic evaluation of the patellar tendon after harvesting its central third. Am J Sports Med 2000; 28: 218–226.

    CAS  PubMed  Google Scholar 

  99. Hou, CH, CL Wang, and CC Lin. Ultrasound examination of patellar tendon after harvest for anterior cruciate ligament reconstruction. J Formos Med Assoc 2001; 100: 315–318.

    CAS  PubMed  Google Scholar 

  100. Adriani, E, PP Mariani, G Maresca, and N Santori. Healing of the patellar tendon after harvesting of its mid-third for anterior cruciate ligament reconstruction and evolution of the unclosed donor site defect. Knee Surg Sports Traumatol Arthrosc 1995; 3: 138–143.

    Article  CAS  PubMed  Google Scholar 

  101. Cerullo, G, G Puddu, E Gianni, A Damiani, and F Pigozzi. Anterior cruciate ligament patellar tendon reconstruction: It is probably better to leave the tendon defect open! Knee Surg Sports Traumatol Arthrosc 1995; 3: 14–17.

    Article  CAS  PubMed  Google Scholar 

  102. Rosenberg, TD, JL Franklin, GN Baldwin, and KA Nelson. Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20: 519–525.

    CAS  PubMed  Google Scholar 

  103. Kartus, J, S Lindahl, K Köhler, N Sernert, BI Eriksson, and J Karlsson. Serial magnetic resonance imaging of the donor site after harvesting the central third of the patellar tendon: A prospective study of 37 patients after arthroscopic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1999; 7: 20–24.

    CAS  PubMed  Google Scholar 

  104. Bernicker, JP, JL Haddad, DM Lintner, TC DiLiberti, and JR Bocell. Patellar tendon defect during the first year after anterior cruciate ligament reconstruction: Appearance on serial magnetic resonance imaging. Arthroscopy 1998; 14: 804–809.

    CAS  PubMed  Google Scholar 

  105. Koseoglu, K, A Memis, M Argin, and R Arkun. MRI evaluation of patellar tendon defect after harvesting its central third. Eur J Radiol 2004; 50: 292–295.

    Article  PubMed  Google Scholar 

  106. Kiss, ZS, DP Kellaway, JL Cook, and KM Khan. Postoperative patellar tendon healing: An ultrasound study. VIS Tendon Study Group. Australas Radiol 1998; 42: 28–32.

    CAS  PubMed  Google Scholar 

  107. Cross, MJ, G Roger, P Kujawa, and IF Anderson. Regeneration of the semitendinosus and gracilis tendons following their transection for repair of the anterior cruciate ligament. Am J Sports Med 1992; 20: 221–223.

    CAS  PubMed  Google Scholar 

  108. Simonian, PT, SD Harrison, VJ Cooley, EM Escabedo, DA Deneka, and RV Larson. Assessment of morbidity of semitendinosus and gracilis tendon harvest for ACL reconstruction. Am J Knee Surg 1997; 10: 54–59.

    CAS  PubMed  Google Scholar 

  109. Eriksson, K, LG Kindblom, P Hamberg, H Larsson, and T Wredmark. The semitendinosus tendon regenerates after resection: A morphologic and MRI analysis in 6 patients after resection for anterior cruciate ligament reconstruction. Acta Orthop Scand 2001; 72: 379–384.

    Article  CAS  PubMed  Google Scholar 

  110. Eriksson, K, H Larsson, T Wredmark, and P Hamberg. Semitendinosus tendon regeneration after harvesting for ACL reconstruction: A prospective MRI study. Knee Surg Sports Traumatol Arthrosc 1999; 7: 220–225.

    CAS  PubMed  Google Scholar 

  111. Papandrea, P, MC Vulpiani, A Ferretti, and F Conteduca. Regeneration of the semitendinosus tendon harvested for anterior cruciate ligament reconstruction: Evaluation using ultrasonography. Am J Sports Med 2000; 28: 556–561.

    CAS  PubMed  Google Scholar 

  112. Battlehner, CN, M Carneiro Filho, JM Ferreira, Jr., PH Saldiva, and GS Montes. Histochemical and ultrastructural study of the extracellular matrix fibers in patellar tendon donor site scars and normal controls. J Submicrosc Cytol Pathol 1996; 28: 175–186.

    CAS  PubMed  Google Scholar 

  113. Proctor, CS, DW Jackson, and TM Simon. Characterization of the repair tissue after removal of the central one-third of the patellar ligament. An experimental study in a goat model. J Bone Joint Surg [Am] 1997; 79: 997–1006.

    CAS  PubMed  Google Scholar 

  114. Sanchis-Alfonso, V, A Subias-Lopez, C Monteagudo-Castro, and E Rosello-Sastre. Healing of the patellar tendon donor defect created after central-third patellar tendon autograft harvest: A long-term histological evaluation in the lamb model. Knee Surg Sports Traumatol Arthrosc 1999; 7: 340–348.

    Article  CAS  PubMed  Google Scholar 

  115. Burks, RT, RC Haut, and RL Lancaster. Biomechanical and histological observations of the dog patellar tendon after removal of its central one-third. Am J Sports Med 1990; 18: 146–153.

    CAS  PubMed  Google Scholar 

  116. Svensson, M, J Kartus, LR Christensen, T Movin, N Papadogiannakis, and J Karlsson. A long-term serial histological evaluation of the patellar tendon in humans after harvesting its central third. Knee Surg Sports Traumatol Arthrosc 2005; Feb 1 (Epub ahead of print).

    Google Scholar 

  117. LaPrade, RF, CD Hamilton, RD Montgomery, F Wentorf, and HD Hawkins. The reharvested central third of the patellar tendon: A histologic and biomechanical analysis. Am J Sports Med 1997; 25: 779–785.

    CAS  PubMed  Google Scholar 

  118. Scherer, MA, HJ Fruh, R Ascherl, and W Siebels. Biomechanical studies of change in the patellar tendon after transplant removal. Aktuelle Traumatol 1993; 23: 129–132.

    CAS  PubMed  Google Scholar 

  119. Amiel, D, JB Kleiner, and WH Akeson. The natural history of the anterior cruciate ligament autograft of patellar tendon origin. Am J Sports Med 1986; 14: 449–462.

    CAS  PubMed  Google Scholar 

  120. Amiel, D, C Frank, F Harwood, J Fronek, and W Akeson. Tendons and ligaments: A morphological and biochemical comparison. J Orthop Res 1984; 1: 257–265.

    CAS  PubMed  Google Scholar 

  121. Vogel, KG, A Ordog, G Pogany, and J Olah. Proteoglycans in the compressed region of human tibialis posterior tendon and in ligaments. J Orthop Res 1993; 11: 68–77.

    Article  CAS  PubMed  Google Scholar 

  122. Movin, T, A Gad, FP Reinholt, and C Rolf. Tendon pathology in long-standing achillodynia: Biopsy findings in 40 patients. Acta Orthop Scand 1997; 68: 170–175.

    CAS  PubMed  Google Scholar 

  123. Khan, KM, F Bonar, PM Desmond, JL Cook, DA Young, PJ Visentini, MW Fehrmann, ZS Kiss, PA O’Brien, PR Harcourt, RJ Dowling, RM O’Sullivan, KJ Crichton, BM Tress, and JD Wark. Patellar tendinosis (jumper’s knee): Findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology 1996; 200: 821–827.

    CAS  PubMed  Google Scholar 

  124. Green, JS, B Morgan, I Lauder, DB Finlay, and M Allen. Correlation of magnetic resonance imaging and histology in patellar tendinitis. Sports Exercise and Injury 1997; 3: 80–84.

    Google Scholar 

  125. Kannus, P, and L Jozsa. Histopathological changes preceding spontaneous rupture of a tendon: A controlled study of 891 patients. J Bone Joint Surg [Am] 1991; 73: 1507–1525.

    CAS  PubMed  Google Scholar 

  126. Liu, SH, RS Yang, R al-Shaikh, and JM Lane. Collagen in tendon, ligament, and bone healing: A current review. Clin Orthop 1995; 318: 265–278.

    PubMed  Google Scholar 

  127. Matsumoto, N, S Horibe, N Nakamura, T Senda, K Shino, and T Ochi. Effect of alignment of the transplanted graft extracellular matrix on cellular repopulation and newly synthesized collagen. Arch Orthop Trauma Surg 1998; 117: 215–221.

    Article  CAS  PubMed  Google Scholar 

  128. Burgeson, RE, and ME Nimni. Collagen types: Molecular structure and tissue distribution. Clin Orthop 1992; 282: 250–272.

    PubMed  Google Scholar 

  129. Cheung, DT, P DiCesare, PD Benya, E Libaw, and ME Nimni. The presence of intermolecular disulfide cross-links in type III collagen. J Biol Chem 1983; 258: 7774–7778.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, NÄL-Hospital, Trollhättan, Sweden

    Jüri Kartus MD, PhD

  2. Department of Orthopaedics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

    Tomas Movin MD, PhD

  3. Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden

    Jon Karlsson MD, PhD

Authors
  1. Jüri Kartus MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomas Movin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jon Karlsson MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Vicente Sanchis-Alfonso MD, PhD (Member of the International Patellofemoral Study Group/Member of the ACL Study Group) (Member of the International Patellofemoral Study Group/Member of the ACL Study Group)

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag London Limited

About this chapter

Cite this chapter

Kartus, J., Movin, T., Karlsson, J. (2006). Donor-Site Morbidity after Anterior Cruciate Ligament Reconstruction Using Autografts. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, London. https://doi.org/10.1007/1-84628-143-1_19

Download citation

  • DOI: https://doi.org/10.1007/1-84628-143-1_19

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-003-0

  • Online ISBN: 978-1-84628-143-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation