Bone Grafting of the Bone Defects after Harvesting the Bone Patellar Tendon Bone Graft - A Novel Surgical Technique

Abstract

Introduction: The anterior knee pain is the most common post-operative complaint associated with anterior cruciate ligament reconstruction (ACLR) using bone patellar tendon bone graft. It has been attributed to various factors such as loss of terminal extension, infrapatellar branch neuroma, and also due to the bone harvest site defect itself. Bone grafting of the defects in the patella and tibia has been shown to decrease anterior knee pain. At the same time, it also prevents post-operative stress fractures.

Surgical technique: Numerous bone pieces were produced in the knee joint as a result of the drilling during ACL reconstruction. Using a wash cannula and tissue grasper, all the bone fragments were gathered into a kidney tray. The bony fragments with the saline which were collected in the metal container were allowed to sediment at the bottom. The bone that was sedimented in the metal container was collected by decantation and placed into the bony defects of the patellar and tibial sides.

Conclusion: Bone grafting of the defects in the patella and tibia has been shown to decrease anterior knee pain. Our technique is cost-effective as there is no requirement for special instrumentation like coring reamers, and no requirement for allograft or bone substitutes. Second, there is no morbidity associated with autografts harvested from elsewhere, we used the bone generated during the ACLR itself.

Keywords: Anterior cruciate ligament reconstruction; anterior knee pain; bone graft; bone patellar tendon bone graft.

Figure 1

(a) Bone defects post bone graft harvest at the patellar and tibial sides. (b) The BPTB graft was prepared with sutures on either side.

Figure 2

Bone fragments were generated during tunnel preparation.

Figure 3

The bone fragments generated during tunnel preparations are collected using, (a) wash cannula (b) tissue grasper (c) wash cannula outer side in anteromedial portal (d) bone fragments collected from drill flutes.

Figure 4

Sedimentation of bone fragments and decantation of collected bone fragments.

Figure 5

The bone fragments are used as an autograft for filling the patellar and tibial bone defects (a-c), the paratenon is closed after filling the bone defects (d).