Length of the patellar tendon after anterior cruciate ligament reconstruction with patellar tendon autograft: A prospective clinical study using Roentgen stereometric analysis

Purpose: This prospective study was designed to assess postoperative changes in patellar tendon length after removal of its central one third for anterior cruciate ligament (ACL) reconstruction using precise Roengen stereometric analysis (RSA). Type of Study: Prospective clinical study. Methods: Ten consecutive patients underwent arthroscopically assisted ACL reconstruction using the mid-third bone-patellar tendon-bone (BPTB) autograft. The tendon defect was left open and the paratenon was approximated with sutures. Tantalum beads were inserted in the distal part of the patella and in the tibial tuberosity through the bone defects. The distance between the tantalum markers in the patella and the tibial tuberosity was measured with RSA at the first day and at 1, 2, 3, 6, and 12 months after surgery. Results: A decrease of patellar tendon length was observed in all cases. The amount of shortening averaged 1.6 mm (range, 0.5 to 3.2 mm), 3.2% of the initial length. In 4 patients, tendon shortening was detected during the first 4 weeks after surgery. In 6 cases, decrease of patellar tendon length started between the fourth and the eighth week. The shortening process continued in 8 knees until the 12th week. No further changes in patellar tendon length were observed after the 12th postoperative week. In 2 patients, shortening of the patella tendon exceeded 2 mm. The amount of patellar tendon shortening was not related to anterior knee pain. Conclusions: After removing the BPTB autograft, irreversible shortening of the remaining two thirds of the patellar tendon occurred during the first 12 postoperative weeks.