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Patellar tendon augmentation after removal of its central third limits joints tissue changes
P J Atkinson1, M Oyen-Tiesma, D K Zukosky
1Department of Materials Science and Mechanics, College of Engineering, Michigan State University, East Lansing 48824, USA.
Summary
Augmentation devices can limit knee joint complications after anterior cruciate ligament reconstruction using patellar tendon grafts. These devices help maintain tendon dimensions and reduce fibrosis, improving tissue quality.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Sports medicine
Background:
- Anterior cruciate ligament (ACL) reconstruction frequently uses the central third of the patellar tendon.
- Post-operative joint tissue changes, including tendon remodeling and fat pad fibrosis, have been observed.
- These changes may stem from increased stress on the remaining patellar tendon after graft harvest.
Purpose of the Study:
- To investigate the efficacy of augmentation devices in mitigating adverse tissue changes after patellar tendon harvest.
- To evaluate the impact of augmentation on tendon healing, dimensions, and structural properties.
- To assess the effect of augmentation on infrapatellar fat pad fibrosis.
Main Methods:
- Excision of the central third of the patellar tendon in three rabbit groups.
- Application of two different augmentation devices to the tendon defects in two groups.
- A 12-week treadmill exercise regimen for all rabbits.
- Biomechanical and histological analysis of the patellar tendons and surrounding tissues.
Main Results:
- Non-augmented tendons showed significant increases in cross-sectional area (112%) and length (16%), with widespread remodeling and fat pad fibrosis.
- Augmentation significantly reduced these changes, with the greatest reduction observed in the group with maximal augmentation.
- Augmented tendons maintained dimensions similar to the intact contralateral tendon, with remodeling confined to the defect area.
- Augmented tendons exhibited minimal to no fat pad fibrosis.
- Despite size differences, augmented and non-augmented tendons had similar structural properties, suggesting higher tissue quality in augmented tendons.
Conclusions:
- Implantation of augmentation devices can limit patellar tendon proliferation and infrapatellar fat pad fibrosis after ACL reconstruction.
- Augmentation supports tendon healing, preserving native tendon dimensions and structural integrity.
- These findings suggest a potential strategy to improve outcomes following ACL reconstruction using autogenous patellar tendon grafts.