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Quantitative assessment of patellar vascularity following bone-patellar tendon-bone autograft harvest for ACL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Recent anatomic studies have suggested that the dominant arterial supply of the patella enters through the inferior pole. Based upon these findings, we hypothesized that bone-patellar tendon-bone graft harvest can significantly diminish patellar vascularity.

Methods

Nine matched pair cadaveric knee specimens (mean age 47.4 years) were dissected and cannulated. A single knee was selected to undergo routine graft harvest, and the contralateral knee was left intact to serve as a control. Gadolinium was injected, and magnetic resonance imaging (MRI) signal enhancement was quantified to determine differences in uptake. Each matched pair was subsequently injected with a urethane polymer compound and dissected to correlate vessel disruption with MRI findings.

Results

We identified two predominating patterns of vessel entry. In one pattern, the vessel entered the inferomedial aspect (five o’clock/right, seven o’clock/left) of the patella and was disrupted by graft harvest in 2/9 (22.2 %) pairs. In the second pattern, the vessel entered further medial (four o’clock/right, eight o’clock/left) and was not disrupted (7/9, 78.8 %). The mean decrease in gadolinium uptake following disruption of the predominant vessel measured 56.2 % (range 42.6–69.5 %) compared to an average decrease of 18.3 % (range 7.1–29.1 %) when the dominant arterial supply to the inferior pole remained intact (p < 0.04).

Conclusion

Medial entry of the predominant vessel precluded vessel disruption. Disruption of the dominant arterial supply can result in a significant decrease in patellar vascularity. Modification of graft harvest techniques and areas of surgical dissection should be explored to minimize vascular insult. Further correlation with clinical studies/outcomes is necessary to determine a potential association between vascular insult and anterior knee pain.

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Acknowledgments

The study was approved by the institutional review board at the Hospital for Special Surgery.

Conflict of interest

The authors have no financial disclosures relevant to this study.

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Authors and Affiliations

  1. David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, 76-143 CHS, Los Angeles, CA, 90095, USA

    Kristofer J. Jones

  2. Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA

    Lionel E. Lazaro, Samuel A. Taylor, Nadine C. Pardee, Jo A. Hannafin, Russell F. Warren & Dean G. Lorich

  3. Citigroup Biomedical Imaging Center, Weill Medical College of Cornell University, 516 E. 72nd St, New York, NY, 10021, USA

    Jonathan P. Dyke

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  1. Kristofer J. Jones
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Correspondence to Kristofer J. Jones.

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Jones, K.J., Lazaro, L.E., Taylor, S.A. et al. Quantitative assessment of patellar vascularity following bone-patellar tendon-bone autograft harvest for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 24, 2818–2824 (2016). https://doi.org/10.1007/s00167-015-3510-2

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  • DOI: https://doi.org/10.1007/s00167-015-3510-2

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