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. 2025 Jul 3.
doi: 10.5435/JAAOS-D-24-01217. Online ahead of print.

The Effect of Mild-to-Moderate Preoperative Patellar Tendinopathy in Autografts Used for Anterior Cruciate Ligament Reconstruction on Postoperative Outcomes

Michelle Xiao  1 , Robert Putko, Jessica N Nguyen, Seth L Sherman, Marc R Safran, Geoffrey D Abrams
Affiliations

The Effect of Mild-to-Moderate Preoperative Patellar Tendinopathy in Autografts Used for Anterior Cruciate Ligament Reconstruction on Postoperative Outcomes

Michelle Xiao et al. J Am Acad Orthop Surg. .

Abstract

Introduction: The purpose of this study was to investigate whether patellar tendinopathy on preoperative MRI in patients undergoing anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) autograft has an effect on retears, subsequent surgeries, and postoperative patient-reported outcomes (PROs).

Methods: Patients who underwent primary or revision ACL reconstruction with BTB autograft with preoperative MRI and minimum 2 years of follow-up were included. Concomitant procedures, demographic data, retears, and subsequent surgeries were documented. MRI scans were graded for patellar tendinopathy by two independent reviewers. Cohorts were created based on tendinopathy findings (Grade 0-no tendinopathy; Grade 1-mild; Grade 2-moderate; and Grade 3-severe). PRO questionnaires were sent to included patients postoperatively. Multivariable logistic regression evaluated odds of retear and revision surgery between groups. Multivariable linear regression evaluated PROs between tendinopathy grades.

Results: Nine hundred nine knees (795 primary, 114 revision; 63% male; 44.4% grade 0, 42.7% grade 1, 11.7% grade 2, and 1.2% grade 3 tendinopathy) were included. A total of 89 subsequent surgeries were included, with 16 revisions. After controlling for covariates, there were no notable differences in odds of ACL retear or revision surgery for grades 1, 2, and 3 tendinopathy compared with no tendinopathy. Concomitant medial meniscus repair at the index procedure was significantly associated with increased odds of revision surgery (odds ratio 2.9 [1.8 to 4.6]; P < 0.001). No significant differences were detected in all PROs between grade 0, 1, and 2 tendinopathy, except for a 5.2-point higher Single Assessment Numeric Evaluation, for grade 1 versus no tendinopathy (P = 0.03). Regardless of tendinopathy status, patients with a subsequent surgery scored markedly worse on all PROs measured, except for the total Knee Injury and Osteoarthritis Outcome Score.

Conclusion: This large study of over 900 knees demonstrates that patients with evidence of mild-moderate patellar tendinopathy on MRI before undergoing ACL reconstruction with BTB autograft have no notable differences in ACL retear rates and rates of subsequent ipsilateral knee surgery.

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References

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