title: Patella fracture after anterior cruciate ligament reconstruction with the patellar tendon: a comparison between different shaped bone block excisions.
abstract: Tensile failure of a patella after anterior cruciate ligament (ACL) reconstruction with autogenous patellar tendon graft is an uncommon but serious complication. One factor that may affect post-harvest patella strength is the shape of the bony defect. The effect of patella defect shape on ultimate tensile strength and mode of failure of the extensor mechanism has not been studied using physiologic moments. Twelve matched pair knee specimens were randomly distributed within three groups comparing rectangular versus triangular, rectangular versus circular, and circular versus triangular shaped patella defects. Specimens were loaded in tension to failure using physiologic moments. Patella fracture occurred in 21 of 24 specimens. Mean ultimate strength for all patellae with a circular defect was 2540 N (+/-651), rectangular defect was 3267 N (+/-920), and triangular defect was 3009 N (+/-1057). There was no significant difference in mean ultimate tensile strength between defect shapes or between matched pairs within the groups. Mode of failure also was similar in all three groups. No defect shape was found to be superior in this investigation comparing ultimate tensile strength or mode of failure between different shaped patella defects.
authors.affiliation: Department of Orthopedic Surgery, University of Washington, Seattle, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: DuMontier
authors.forename: M H
authors.initials: MH
authors.lastname: Metcalf
authors.forename: P T
authors.initials: PT
authors.lastname: Simonian
authors.forename: R V
authors.initials: RV
authors.lastname: Larson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D002102:Cadaver; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods*; D010329:Patella / Q000293:injuries*; D017847:Patellar Ligament / Q000637:transplantation*; D013709:Tendon Transfer / Q000009:adverse effects*; D013718:Tensile Strength