Observations on a Retrieved Patellar Tendon Autograft Used to Reconstruct the Anterior Cruciate Ligament: A Case Report

Torn anterior cruciate ligaments are commonly replaced with central-third bone-patellar tendon-bone autografts1. Many animal models have been used to study the revascularization process of patellar tendon autografts after reconstruction2-8. However, only biopsy material, usually superficial, from successfully functioning human anterior cruciate reconstructions have been evaluated9-13. We are reporting a case in which the entire knee joint was retrieved at autopsy on a twenty-six-year-old athlete in whom a torn anterior cruciate ligament had been replaced with a central-third bone-patellar tendon-bone autograft eighteen months earlier. To our knowledge, this is the first such analysis of a retrieved patellar tendon autograft that had been used to replace the anterior cruciate ligament. A twenty-six-year-old man tore an anterior cruciate ligament while playing basketball. Because of recurrent instability, surgery was performed three years later. Preoperative radiographs revealed normal findings. Examination with the patient under anesthesia revealed a result of 2+ on the Lachman test and a positive pivot shift. Arthroscopic examination confirmed a complete rupture of the anterior cruciate ligament, a torn lateral meniscus, and a bucket-handle tear of the medial meniscus. The lateral meniscal tear was resected, and the torn medial meniscus was excised. A central-third bone-patellar tendon-bone autograft was used to replace the torn anterior cruciate ligament under arthroscopic visualization with use of a two-incision technique. A 5 to 6-mm-deep groove was fashioned through an anterior approach with use of a curved rasp in the posterolateral aspect of the intercondylar notch. The autograft was passed through a tibial tunnel, and the patellar bone segment was secured to the posterior cortex of the distal part of the femur with a single small-fragment AO screw. The patellar tendon portion of the graft was positioned on the femoral side in the posterolateral rasped groove in the …