Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.
Dr. Balog is a Staff Orthopedic Surgeon, Tripler Army Medical Center, Honolulu, Hawaii. Mr. Blanks is a Staff Physician Assistant, OrthoGeorgia, Macon, Georgia. Dr. Dykstra is a Staff Orthopedic Surgeon, Black Hills Orthopedic and Spine Center, Rapid City, South Dakota. Dr. Parada is Staff Orthopedic Surgeon, Eisenhower Army Medical Center, Fort Gordon, Georgia. Dr. Arrington is a Staff Orthopedic Surgeon and Director, Orthopedic Surgery Residency Program, Madigan Army Medical Center, Tacoma, Washington.
Address correspondence to: LTC Todd P. Balog, MD, 1 Jarrett White Rd, Honolulu, HI 96859 (tel, 832-326-5583; email, tbalog99@gmail.com).
MAJ Todd P. Balog, MD MAJ Benjamin P. Blanks, PA MAJ Aaron D. Dykstra, MD MAJ Stephen A. Parada, MD COL (ret) Edward D. Arrington, MD . Epidemiology of Existing Extensor Mechanism Pathology in Primary Anterior Cruciate Ligament Ruptures in an Active-Duty Population. Am J Orthop.
August 31, 2018
TAKE-HOME POINTS
Extensor mechanism pathology is a common finding in patients with ACL injuries.
Extensor mechanism pathology such as a multipartite patella, unresolved Osgood-Schlatter’s disease, and patella tendinopathy are easily identifiable on standard imaging.
It is unknown what type of effect, if any, these pathologies may have on graft strength.
The bone-patella tendon-bone and quadriceps autograft are the most likely to be affected.
Surgeons should take into account existing extensor mechanism pathology when considering individual patient graft selection for ACL reconstruction.
References
ABSTRACT
The purpose of this study is to determine the prevalence of potential graft-influencing pathologies of the extensor mechanism of the knee in patients presenting with a primary anterior cruciate ligament (ACL) rupture.
We performed a retrospective review of the plain radiographs and magnetic resonance imaging (MRI) of all active-duty patients presenting with a primary ACL rupture at our institution between July 2006 and February 2009. Imaging was reviewed to determine the presence of a multipartite patella, unresolved Osgood-Schlatter’s disease, and/or radiographic evidence suggestive of patella tendinopathy.
A total of 197 patients were reviewed, including 27 females and 170 males. One patient (0.5%) had a bipartite patella and 4 patients (2%) had free-floating ossicles about the tibial tuberosity consistent with unresolved Osgood-Schlatter’s disease. A total of 15 patients (7.6%) showed MRI evidence suggestive of patella tendinopathy.
This study revealed 20 patients out of 197 (10.1%) who presented with existing extensor mechanism pathologies in radiologic studies. While preoperative imaging is routinely used to confirm clinical suspicion of ACL rupture or identify associated injuries, this study shows that it can also identify existing extensor mechanism pathologies that could ultimately influence the use of an extensor mechanism graft.
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