J Knee Surg 2017; 30(05): 467-473
DOI: 10.1055/s-0036-1593364
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Efficacy of β-Tricalcium Phosphate Graft into the Bone Defects after Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction

Hiroshi Higuchi
1   Department of Orthopaedic Surgery, Asakura Sports Rehabilitation Clinic, Maebashi, Japan
,
Atsushi Kobayashi
1   Department of Orthopaedic Surgery, Asakura Sports Rehabilitation Clinic, Maebashi, Japan
,
Keiko Ikeda
2   Department of Clinical Pathology, Asakura Sports Rehabilitation Clinic, Maebashi, Japan
,
Kazuhisa Hatayama
3   Department of Orthopaedic Surgery, Gunma Chuo Hospital, Maebashi, Japan
,
Sinya Yanagisawa
4   Department of Orthopaedic Surgery, Zenshukai Hospital, Maebashi, Japan
,
Kazuo Kato
5   Department of Rehabilitation, Asakura Sports Rehabilitation Clinic, Maebashi, Japan
› Author Affiliations
Further Information

Publication History

19 April 2016

07 August 2016

Publication Date:
28 September 2016 (online)

Abstract

This prospective pilot study investigated whether grafting β-tricalcium phosphate (B-TCP) into the bone-patellar tendon-bone (BPTB)-harvesting site after anterior cruciate ligament reconstruction would accelerate bone and tendon regeneration in the grafted site. Overall, 19 patients agreed prospectively to undergo regular morphological and histological examinations of the B-TCP-grafted site. Postoperative radiographic, ultrasonographic, and magnetic resonance imaging (MRI) examinations were performed to evaluate the grafted site at 1, 3, 6, and 12 months. Postoperative knee function and donor-site morbidity were assessed at 12 months using the kneeling test. A histological examination was also performed at this time Radiographic examination and MRI showed that the grafted B-TCP was completely absorbed and remodeled into normal bone structure in the tibia and patella at 6 months postoperatively. Histological and ultrasonographic examinations of all subjects showed that the grafted B-TCP was substituted by normal bone tissue, and the patellar tendon − bone junction had regenerated at 12 months postoperatively. Clinical functional knee tests showed good recovery of the donor site. All patients could perform kneeling and knee walking on hard ground. The results of this pilot study suggest that grafting B-TCP into the BPTB-harvesting site promotes the remodeling process of the bone and patellar tendon structures. This surgical treatment would decrease an incidence of the anterior knee pain after ACLR using a BPTB autograft.

 
  • References

  • 1 Harner CD, Fu FH, Irrgang JJ, Vogrin TM. Anterior and posterior cruciate ligament reconstruction in the new millennium: a global perspective. Knee Surg Sports Traumatol Arthrosc 2001; 9 (06) 330-336
  • 2 Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 2007; 35 (04) 564-574
  • 3 Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 1984; 66 (03) 344-352
  • 4 Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 1991; 19 (03) 217-225
  • 5 Manifold SG, Cushner FD, Scott WN. Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: Indications, technique, complications, and management. In: Scott WN. ed. Surgery of the Knee. Fourth Edition. Philadelphia, PA: Churchill Livingstone; 2006: 632-646
  • 6 Sajovic M, Strahovnik A, Dernovsek MZ, Skaza K. Quality of life and clinical outcome comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: an 11-year follow-up of a randomized controlled trial. Am J Sports Med 2011; 39 (10) 2161-2169
  • 7 Ferrari JD, Bach Jr BR. Bone graft procurement for patellar defect grafting in anterior cruciate ligament reconstruction. Arthroscopy 1998; 14 (05) 543-545
  • 8 Sharkey NA, Donahue SW, Smith TS, Bay BK, Marder RA. Patellar strain and patellofemoral contact after bone-patellar tendon-bone harvest for anterior cruciate ligament reconstruction. Arch Phys Med Rehabil 1997; 78 (03) 256-263
  • 9 Tsuda E, Okamura Y, Ishibashi Y, Otsuka H, Toh S. Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Am J Sports Med 2001; 29 (04) 450-456
  • 10 Walsh WR, Vizesi F, Michael D. , et al. Beta-TCP bone graft substitutes in a bilateral rabbit tibial defect model. Biomaterials 2008; 29 (03) 266-271
  • 11 Gaasbeek RD, Toonen HG, van Heerwaarden RJ, Buma P. Mechanism of bone incorporation of beta-TCP bone substitute in open wedge tibial osteotomy in patients. Biomaterials 2005; 26 (33) 6713-6719
  • 12 Rihn JA, Kirkpatrick K, Albert TJ. Graft options in posterolateral and posterior interbody lumbar fusion. Spine 2010; 35 (17) 1629-1639
  • 13 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3–4): 226-234
  • 14 Harner CD, Honkamp NJ, Ranawat AS. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy 2008; 24 (01) 113-115
  • 15 Kartus J, Movin T, Papadogiannakis N, Christensen LR, Lindahl S, Karlsson J. A radiographic and histologic evaluation of the patellar tendon after harvesting its central third. Am J Sports Med 2000; 28 (02) 218-226
  • 16 Hoksrud A, Ohberg L, Alfredson H, Bahr R. Color Doppler ultrasound findings in patellar tendinopathy (jumper's knee). Am J Sports Med 2008; 36 (09) 1813-1820
  • 17 Klauser AS, Franz M, Arora R. , et al. Detection of vascularity in wrist tenosynovitis: power doppler ultrasound compared with contrast-enhanced grey-scale ultrasound. Arthritis Res Ther 2010; 12 (06) R209
  • 18 Salmon LJ, Russell VJ, Refshauge K. , et al. Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 2006; 34 (05) 721-732
  • 19 Ahn JH, Kim JG, Wang JH, Jung CH, Lim HC. Long-term results of anterior cruciate ligament reconstruction using bone-patellar tendon-bone: an analysis of the factors affecting the development of osteoarthritis. Arthroscopy 2012; 28 (08) 1114-1123
  • 20 Beswick A, Blom AW. Bone graft substitutes in hip revision surgery: a comprehensive overview. Injury 2011; 42 (Suppl. 02) S40-S46
  • 21 Lerner T, Bullmann V, Schulte TL, Schneider M, Liljenqvist U. A level-1 pilot study to evaluate of ultraporous beta-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis. Eur Spine J 2009; 18 (02) 170-179
  • 22 Epstein NE. Beta tricalcium phosphate: observation of use in 100 posterolateral lumbar instrumented fusions. Spine J 2009; 9 (08) 630-638