title: Bone-patellar tendon-bone graft via a single minimally-invasive approach versus a classical approach in anterior cruciate ligament reconstruction: a prospective study.
abstract: Harvesting the patellar ligament for anterior cruciate ligament reconstructions can be a source of anterior knee pain and hypoesthesia of the lateral side of the knee. We analyzed the feasibility of a minimally-invasive technique via a single patellar approach and postulate that it reduces anterior pain and limits the hypoesthesia area.
  
  
  METHODS
  A prospective, comparative, non-randomized, single-center study was conducted on two groups: one undergoing surgery with the classical anteromedial approach, the other with the minimally-invasive approach. Each group included 20 patients. Both series were reviewed between the 6th and 8th month after surgery. The revision was clinical, radiological, and ultrasonographic.
  
  
  RESULTS
  The grafts harvested via the classical approach in all 20 cases presented good characteristics, versus eight out of 18 for the grafts harvested via the minimally-invasive approach. A prominent anterior tibial tuberosity improved the quality of the tibial bone block. A hypoesthesia zone was found in 16 cases out of 18 in the classical approach group, it measured a mean 10.3 ± 5.6 cm(2). A surface area of 3 cm(2) was noted in one case from the minimally-invasive group. No significant difference was found for the subjective and objective IKDC and Lille patellofemoral scores between the two groups. Anterior pain was present in four patients in the classical group and six in the minimally-invasive group.
  
  
  CONCLUSIONS
  The minimally-invasive technique reduces the risk of cutaneous hypoesthesia. It does not prevent anterior pain related to harvesting the patellar tendon and a good-quality transplant can be obtained if the anterior tibial tuberosity is prominent.
  
  
  METHODS
  Level III: case-control study.
authors.affiliation: Department of Orthopaedics, Semur-en-Auxois Hospital Center, 3, avenue Pasteur, 21140 Semur-en-Auxois, France.
authors.forename: A
authors.initials: A
authors.lastname: Ioncu
authors.forename: R
authors.initials: R
authors.lastname: Mader
authors.forename: N
authors.initials: N
authors.lastname: Bonin
authors.forename: P-J
authors.initials: PJ
authors.lastname: Ternamian
authors.forename: D
authors.initials: D
authors.lastname: Dejour
mesh_terms: D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D050376:Bone-Patellar Tendon-Bone Grafting / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome