title: Extensor mechanism disruption after contralateral middle third patellar tendon harvest for anterior cruciate ligament revision reconstruction.
abstract: The contralateral central third patellar tendon autograft is a reliable graft choice for revision, and recently, for primary reconstruction of the anterior cruciate ligament (ACL). We report 2 complications including a lateral third tibial tuberosity fracture and a distal patellar tendon avulsion with contralateral patellar tendon autograft with disruption of the extensor mechanism of the donor knee. A patient sustained a lateral tibial tuberosity fracture of the donor knee and underwent open reduction and internal fixation. At 1-year follow-up, she had no extensor lag and full range of motion. Another patient sustained a distal patellar tendon avulsion of the donor knee and underwent primary repair. Three years postoperatively, she had a full range of motion and no extensor lag. Although contralateral middle third patellar tendon autograft for primary and revision ACL reconstruction is established in the literature, extensor mechanism complications can occur. Technical considerations are important to avoid weakening the remaining patellar tendon insertion. Postoperative nerve blocks or local anesthetics may alter pain feedback for regulation of weight bearing and contribute to overload of the donor knee.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Busfield
authors.forename: Marc R
authors.initials: MR
authors.lastname: Safran
authors.forename: W Dilworth
authors.initials: WD
authors.lastname: Cannon
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001915:Braces; D005260:Female; D005269:Femur / Q000601:surgery / Q000637:transplantation; D005593:Fracture Fixation, Internal; D050724:Fractures, Cartilage / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D017847:Patellar Ligament / Q000637:transplantation*; D011183:Postoperative Complications / Q000209:etiology*; D016059:Range of Motion, Articular; D012421:Rupture / Q000601:surgery; D012865:Skiing / Q000293:injuries; D013977:Tibia / Q000601:surgery / Q000637:transplantation*; D013978:Tibial Fractures / Q000209:etiology*; D000070600:Tibial Meniscus Injuries; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D014182:Transplantation, Autologous; D016474:Weight-Bearing