Patellar Tendon Graft - Uses, Benefits, and Procedure

Introduction

The patellar tendon graft is a surgical procedure to repair damaged or torn ligaments in the knee. In this procedure, a segment of the patellar tendon, which extends from the kneecap to the shinbone, is utilized to replace the impaired ligament.

The patellar tendon is often preferred as a graft because it is strong, durable, and can be easily harvested from the same leg as the damaged ligament. It also has bone-to-bone healing potential, allowing for secure and long-lasting graft fixation to the surrounding bone.

What Are the Uses of Patellar Tendon Graft?

The following are common uses of patellar tendon graft:

• ACL Reconstruction: The most common use of patellar tendon graft is in ACL (Anterior cruciate ligament) reconstruction surgery. This procedure is performed to replace a torn or damaged ACL, one of the major ligaments in the knee joint. The patellar tendon graft is often preferred because it is strong, durable, and easily harvested from the same leg as the damaged ACL.

• PCL Reconstruction: The patellar tendon graft can also be used in a posterior cruciate ligament (PCL) reconstruction surgery. The PCL is another important ligament in the knee joint, and a patellar tendon graft can replace a torn or damaged PCL.

• Revision ACL Surgery: A previously reconstructed ACL can sometimes fail or become re-injured. Revision ACL surgery may be necessary to repair the damage, and a patellar tendon graft can be used as an alternative graft option.

• Multi-Ligament Knee Injuries: Injuries that involve damage to multiple ligaments in the knee, such as the ACL, PCL, and collateral ligaments, can be complex and require multiple surgical procedures. A patellar tendon graft may be used as part of the treatment plan to repair or replace the damaged ligaments.

• Knee Osteochondral Defects: Patellar tendon grafts can also be used to treat knee osteochondral defects, which are parts of damaged cartilage and bone in the knee joint. The graft fills the damaged area and promotes new tissue growth in this procedure.

What Are the Benefits of Patellar Tendon Graft?

There are several benefits to using a patellar tendon graft for knee ligament repair or reconstruction. The following are some of the most significant benefits:

• Strength and Durability: The patellar tendon graft is a strong and durable graft option that can withstand the demands of daily activities and sports. The patellar tendon is the strongest tendon present in the body, and it can provide excellent support for the reconstructed ligament.

• Easy Harvesting: The patellar tendon graft is relatively easy to harvest from the same leg as the damaged ligament, which reduces the risk of complications and makes the procedure more convenient for the patient.

• Low Risk of Graft Failure: The patellar tendon graft has a lower risk of failure than other graft options, such as hamstring tendons or cadaver grafts. The patient is less likely to require revision surgery or experience long-term complications..

• Faster Recovery: Due to its strength and stability, the utilization of a patellar tendon graft may result in expedited recovery and an earlier return to regular activities for patients compared to alternative graft options.

• Better Long-Term Outcomes: Research findings indicate favorable long-term outcomes and a minimal risk of re-injury among patients who undergo ACL reconstruction using a patellar tendon graft.

• Ability to Address Multiple Ligament Injuries: The patellar tendon graft can repair or reconstruct multiple knee ligaments, such as the ACL, PCL, and collateral ligaments. So it is a versatile option for patients with complex knee injuries.

What Are Preoperative Preparation for Patellar Tendon Graft?

Preoperative preparation for a patellar tendon graft surgery typically involves the following steps:

• Medical History Review: The surgeon will review the patient's medical history to ensure they are a suitable candidate for surgery. The assessment of the knee joint and adjacent tissues may encompass a physical examination, blood tests, and imaging studies.

• Medication Management: Patients might receive instructions to discontinue the usage of specific medications, such as blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs), in the weeks preceding the surgery. This reduces the risk of bleeding and other complications during and after the procedure.

• Rehabilitation and Exercise: Patients may be given exercises and rehabilitation protocols to follow in the weeks leading up to surgery. This can help strengthen the knee joint, improve range of motion, and prepare the patient for postoperative recovery.

• Fasting Instructions: Patients will typically be instructed to avoid eating or drinking for a certain period before the surgery to ensure that the stomach is empty during the procedure.

• Anesthesia Consultation: Patients will meet with an anesthesia provider to discuss their options for anesthesia during the surgery. This may include general or regional anesthesia, such as a spinal block or epidural.

• Preoperative Instructions: Patients will receive specific instructions from the surgical team regarding what to wear when arriving at the hospital and other details related to the procedure.

What Are the Steps Involved in Patellar Tendon Graft?

The patellar tendon graft procedure typically involves the following steps:

• Anesthesia: The patient will receive anesthesia, which may be general or regional anesthesia, such as a spinal block or epidural.

• Incision: The surgeon will place an incision in the front of the knee to access the damaged ligament.

• Harvesting the Graft: The surgeon will harvest the patellar tendon graft from the same leg as the damaged ligament. This involves removing a portion of the patellar tendon, including a small piece of bone from the kneecap and a piece from the tibia.

• Preparing the Graft: The harvested graft is then cleaned and prepared for insertion into the knee joint.

• Removing the Damaged Ligament: The surgeon will remove the damaged ligament, such as the ACL, from the knee joint.

• Graft Insertion: The prepared patellar tendon graft is inserted into the knee joint and secured using screws or other fixation devices.

• Wound Closure: The incision is closed with sutures or staples, and a dressing is applied to protect the wound.

What Are the Postoperative Care for Patellar Tendon Graft?

After a patellar tendon graft surgery, postoperative care is crucial for a successful recovery. The following are points of postoperative care:

• Pain Management: Patients typically experience some pain and discomfort following surgery. Patients must follow their doctor's instructions for pain management and report any severe or persistent pain. Pain management may involve medication, such as opioids, non-steroidal anti-inflammatory drugs (NSAIDs), or local anesthetics.

• Physical Therapy: It is an important part of the postoperative care process for patellar tendon graft surgery. Physical therapy aims to promote healing, restore function, and prevent complications such as stiffness or muscle weakness. Patients typically begin physical therapy within a few days of the surgery and continue working with a physical therapist for several months.

• Rest and Immobilization: Patients will need rest and knee joint immobilization for some time following the surgery. This may involve crutches, wearing a brace or splint, or keeping the leg elevated to reduce swelling.

• Wound Care: Patients will need to care for the surgical incision site to prevent infection and promote healing. This may entail maintaining cleanliness and dryness of the wound, regularly changing dressings, and refraining from activities that may provoke irritation or reopening of the wound.

• Follow-Up Appointments: Patients should attend follow-up appointments with their doctor to monitor their progress and address any concerns or complications. These appointments may involve imaging studies to evaluate the knee joint healing and physical exams to assess a range of motion, strength, and stability.

• Gradual Return to Activities: Patients should gradually return to their normal activities and sports following the surgery. The timeline for returning to activities will depend on the individual's progress and the type of activity involved. Patients must follow their doctor's instructions for returning to activities and avoid overexertion or sudden movements that could damage the healing graft.

What Are the Complications of a Patellar Tendon Graft?

Complications following patellar tendon graft surgery may include:

• Infection at the surgical site.

• Graft failure or re-tearing of the ligament.

• Pain and stiffness in the knee joint.

• Numbness or weakness in the leg.

• Blood clots or deep vein thrombosis.

• Reaction to anesthesia or medication.

• Inadequate range of motion or stability in the knee joint.

• Knee joint arthritis or degeneration in the long term.

Conclusion:

Patellar tendon graft surgery is a standard procedure to repair damaged ligaments in the knee joint. The procedure involves harvesting a graft from the patellar tendon, which is then inserted into the knee joint to replace the damaged ligament. While there are risks associated with the surgery, such as infection or graft failure, it is generally considered a safe and effective treatment option. Patients can recover and return to normal activities with proper preoperative preparation and postoperative care.