BEST ACL GRAFT DOESN’T INCREASE RISK OF PATELLOFEMORAL OSTEOARTHRITIS

The patellar tendon is considered the gold standard of graft choices for anterior cruciate ligament (ACL) reconstruction, but some studies have suggested a link between patellar tendon graft (PTG) harvest and increased incidence of patellofemoral osteoarthritis. A recent study by Shelbourne Knee Center of its patients found that using a contralateral or ipsilateral PTG in ACL reconstruction does not lead to increased risk of patellofemoral osteoarthritis.1

The study involved 193 ACL reconstruction patients treated at Shelbourne Knee Center with a PTG (95 ipsilateral and 98 contralateral) for ACL reconstruction. Researchers used graded standard Merchant’s radiographs at baseline and 15 to 25 years post-op to analyze the rates of patellofemoral osteoarthritis and compare patients treated with a contralateral versus an ipsilateral PTG. They divided patients into four groups based on joint space narrowing: none, mild (up to 50%), moderate (50-99%)

While most imaging centers and emergency departments use the sunrise view for knee imaging, Shelbourne Knee Center uses the more accurate Merchant view. In the Merchant view, the knees are bent at 45 degrees and the muscles are relaxed, allowing the patella to settle into the trochlear groove. In the Sunrise view, the knees are at maximum flexion. “The Sunrise view doesn’t provide an adequate view of the patellofemoral joint,” says Laura Bray-Prescott, PT/ LATC, a physical therapist/athletic trainer and research team member at Shelbourne Knee Center. “The Merchant view shows how the patella sits in the femur. The difference between the Sunrise and Merchant views can be like night and day.”

No Increased Risk

Study results show that the rates of patellofemoral osteoarthritis are not higher when a PTG is used during ACL reconstruction. The researchers found no statistically significant differences in:

• Any grade of patellofemoral osteoarthritis rate when comparing the uninvolved normal knee from the ipsilateral group to the contralateral graft donor knee of the contralateral group (9.5% vs 13.3%)

• Rates of moderate to severe patellofemoral osteoarthritis between the two groups.1

This study is part of Shelbourne Knee Center’s research program, which tracks patient outcomes and studies factors related to