title: Alterations of the extensor apparatus after anterior cruciate ligament reconstruction using the medial third of the patellar tendon.
abstract: OBJECTIVE
  The objective of this study was the ultrasound evaluation of the donor defect of the patellar tendon (PT) and the radiologic evaluation of the patella after harvesting of the medial third as a bone-patella tendon-bone (BPTB) graft for anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  This was a cohort study.
  
  
  METHODS
  In 45 patients who had ACL reconstruction, the extensor apparatus of the donor side was studied using ultrasound cross-sections and radiographs (anteroposterior, lateral, and a tangential view of the patella) 3 to 70 months postoperatively. Patients were divided into two groups. The early postoperative group (3 to 30 months postoperative) consisted of 27 patients (group A) and the late postoperative group (31 to 70 months postoperative) consisted of 18 patients (group B). The healthy contralateral extensor apparatus was used as control.
  
  
  RESULTS
  In group A, the standard ultrasound cross-section area of the PT increased by 20.48%, whereas in group B, it decreased by 4.88%. In group A, the patellar height was decreased by 9.21% in the donor side compared with the control. In group B, the patellar height was decreased by 7.02%. In group A, the Merchant's congruence angle increased by 11.59 degrees, and for group B, this angle increased by 3.82 degrees. This finding indicated that, after the 30th postoperative month, lateral displacement of the patella was not statistically significant (P =.38). In addition, no significant differences were found in the lateral patellofemoral angle in either group.
  
  
  CONCLUSIONS
  Our study indicates that the tendon defect is always healed and the final tendon cross-section area is 95% of the contralateral after the 30th postoperative month. In addition, there was a nonsignificant slight lateral displacement of the patella. In contrast, other studies found shown that there is a slight medial displacement of the PT after using the central third as a BPTB graft.
authors.affiliation: Department of Orthopaedic Surgery, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: U G
authors.initials: UG
authors.lastname: Moebius
authors.forename: A D
authors.initials: AD
authors.lastname: Georgoulis
authors.forename: C D
authors.initials: CD
authors.lastname: Papageorgiou
authors.forename: A
authors.initials: A
authors.lastname: Papadonikolakis
authors.forename: J
authors.initials: J
authors.lastname: Rossis
authors.forename: P N
authors.initials: PN
authors.lastname: Soucacos
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries; D008297:Male; D010329:Patella / Q000000981:diagnostic imaging; D011859:Radiography; D013710:Tendons / Q000000981:diagnostic imaging / Q000637:transplantation*; D014463:Ultrasonography; D014945:Wound Healing