Background: Although 10% postoperative patellar tendon shortening after bone–patellar tendon–bone autograft reconstruction of the anterior cruciate ligament has been reported, there are no published studies assessing the effect of shortening on patellofemoral joint biomechanics under physiological loading conditions.
Purpose: To investigate the influence of patellar tendon shortening on patellofemoral joint biomechanics.
Study Design: Controlled laboratory study.
Methods: The authors evaluated the patellofemoral contact area, the location of contact, and the patellofemoral joint reaction force and contact stresses in 7 cadaveric knees before and after 10% patellar tendon shortening. Shortening was achieved using a specially designed device. Experimental conditions simulating those occurring during level walking were employed: physiological quadriceps loads and corresponding angles of tibial rotation were applied at 15 °, 30 °, and 60 ° flexion of the knee. Patellofemoral joint contact areas were measured before and after shortening using the silicone oil–carbon black powder suspension squeeze technique.
Results: After patellar tendon shortening, patellofemoral joint contact areas were displaced proximally on the patellar surface and distally on the femoral surface. Although the contact area increased by 18% at 15 ° of knee flexion (P= .04), no significant change occurred at 30 ° or 60 ° of knee flexion (P> .05). Patellofemoral contact stress remained unchanged after patellar tendon shortening (P> .05) at each flexion angle.
Conclusion: Our results suggest that a 10% shortening of the patellar tendon does not alter patellar contact stresses during locomotion. It is not clear whether apparent changes in contact location in all positions and contact area at 15 ° would have clinical consequences.
Aglietti P, Buzzi R, D'Andria S, Zaccherotti G. Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis. Am J Sports Med. 1992;20:38-45.
2.
Aglietti P, Insall JN, Walker PS, Trent P. A new patella prosthesis: design and application. Clin Orthop Relat Res. 1975;107:175-187.
3.
Alexander RM, Vernon A. The dimensions of the knee and ankle muscle and the forces they exert. J Human Movement Studies. 1975;1:115-123.
4.
Ahmed AM, Burke DL, Hyder A. Force analysis of the patellar mechanism. J Orthop Res. 1987;5:69-85.
5.
Bach BR Jr, Jones GT, Hager CA, Sweet FA, Luergans S. Arthrometric results of arthroscopically assisted anterior cruciate ligament reconstruction using autograft patellar tendon substitution. Am J Sports Med. 1995;23:179-185.
6.
Bach BR Jr, Jones GT, Sweet FA, Hager CA. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution: two-to four-year follow-up results. Am J Sports Med. 1994;22:758-767.
7.
Bonamo JJ, Krinick RM, Sporn AA. Rupture of the patellar ligament after use of its central third for anterior cruciate ligament reconstruction: a report of two cases. J Bone Joint Surg Am. 1984;66:1294-1297.
Burks RT, Haut RC, Lancaster RL. Biomechanical and histological observations of the dog patellar tendon after removal of its central one-third. Am J Sports Med. 1990;18:146-153.
10.
Burnett Q, Fowler PJ. Reconstruction of the anterior cruciate ligament: historical overview. Orthop Clin North Am. 1985;16:143-157.
11.
Burwell JMR, Davis AJ, Allum RL. Anterior knee symptoms after reconstruction of the anterior cruciate ligament using patellar tendon as a graft. Knee. 1998;5:245-248.
12.
Buss DD, Warren RF, Wickiewicz TL, Galinat BJ, Panareillo R. Arthroscopically assisted reconstruction of the anterior cruciate ligament with use of autogenous patellar-ligament grafts: results after twenty-four to forty-two months. J Bone Joint Surg Am. 1993;75:1346-1355.
13.
Chan SCN. The Effect of Tibial Geometry on the Prediction of Tensions in the Cruciate Ligaments of the Human Knee[doctorate thesis]. Leeds, United Kingdom: University of Leeds; 1995.
14.
Clancy WG. Intra-articular reconstruction of the anterior cruciate ligament. Orthop Clin North Am. 1985;16:181-189.
15.
Clancy WG, Nelson DA, Reider B, Narechania RG. Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extraarticuar tendon transfers. J Bone Joint Surg Am. 1982;64:352-359.
16.
Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA. Arthroscopic reconstruction of the anterior cruciate ligament: a comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med. 1999;27:444-454.
17.
D'Agata SD, Pearsall AW, Reider B, Draganich LF. An in vitro analysis of patellofemoral contact areas and pressures following procurement of the central one-third patellar tendon. Am J Sports Med. 1993;21:212-219.
18.
Dandy DJ, Desai SS. Patellar tendon length after anterior cruciate ligament reconstruction. J Bone Joint Surg Br. 1994;76:198-199.
19.
Draganich LF, Andriacchi TP, Andersson GBJ. Interaction between intrinsic knee mechanics and the knee extensor mechanism. J Orthop Res. 1987;5:539-547.
20.
Eilerman M, Thomas J, Marsalka D. The effect of harvesting the central one-third of the patellar tendon on patellofemoral contact pressure. Am J Sports Med. 1992;6:738-741.
21.
Ellis MI, Seedhom BB, Wright V, Dowson D. An evaluation of the ratio between the tensions along the quadriceps tendon and the patellar ligament. Eng Med. 1980;9:189-194.
22.
Finsterbush A, Frankl U, Matan Y, Mann G. Secondary damage to the knee after isolated injury of the anterior cruciate ligament. Am J Sports Med. 1990;18:475-479.
23.
Goldstein SA, Coale E, Weiss AP, Grossnickle M, Meller B, Matthews LS. Patellar surface strain. J Orthop Res. 1986;4:372-377.
24.
Goodfellow J, Hungerford DS, Zindel M. Functional anatomy of the patello-femoral joint. J Bone Joint Surg Br. 1976;58:287-290.
25.
Graf B, Uhr F. Complications of intra-articular anterior cruciate ligament reconstruction. Clin Sports Med. 1988;7:835-848.
26.
Harris ML, Morberg WM, Walsh WR. An improved method for measuring tibio-femoral contact areas in total knee arthroplasty: a comparison of K-Scan sensor and Fuji-film. J Biomech. 1999;32:951-958.
27.
Hehne HJ. Biomechanics of the patellofemoral joint and its clinical relevance. Clin Orthop Relat Res. 1990;258:73-85.
28.
Hille E, Schulitz KP, Henrichs C, Schneider T. Pressure and contactsurface measurements within the femoropatellar joint and their variations following lateral release. Arch Orthop Trauma Surg. 1985;104:275-282.
29.
Hsieh YF, Draganich LF, Ho SH, Reider B. The effects of removal and reconstruction of the anterior cruciate ligament on the contact characteristics of the patellofemoral joint. Am J Sports Med. 2002;30:121-127.
30.
Huberti HH, Hayes WC. Patellofemoral contact pressures: the influence of Q-angle and tendofemoral contact. J Bone Joint Surg Am. 1984;66:715-724.
31.
Huberti HH, Hayes WC, Stone JL, Shybut GT. Force ratios in the quadriceps tendon and ligamentum patellae. J Orthop Res. 1984;2:49-54.
32.
Hungerford DS, Barry M. Biomechanics of the patellofemoral joint. Clin Orthop Relat Res. 1979;144:9-15.
33.
Jackson DW, Jennings LD. Arthroscopically assisted reconstruction of the anterior cruciate ligament using a patellar tendon autograft. Clin Sports Med. 1988;7:785-800.
34.
Jones KG. Reconstruction of the anterior cruciate ligament: a technique using the central one-third of the patellar ligament. J Bone Joint Surg Am. 1963;45:925-932.
35.
Kawakubu L. Tracking of the Patella in Knees with Ligamentous Deficiency[master's thesis]. Leeds, United Kingdom: University of Leeds; 1996.
36.
Kleipool AE, van Loon T, Marti RK. Pain after use of the central third of the patellar tendon for cruciate ligament reconstruction: 33 patients followed 2-3 years. Acta Orthop Scand. 1994;65:62-66.
37.
Lambert KL. Vascularized patellar tendon graft with rigid internal fixation for anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1983;172:85-89.
38.
Lee TQ, Yang BY, Sandusky MD, McMahon PJ. The effects of tibial rotation on the patellofemoral joint: assessment of the changes in in situ strain in the peripatellar retinaculum and the patellofemoral contact pressures and areas. J Rehabil Res Dev. 2001;38:463-469.
39.
Matthews LS, Sonstegard DA, Henke JA. Load bearing characteristics of the patellofemoral joint. Acta Orthop Scand. 1977;48:511-516.
40.
Morrison JB. The Forces Transmitted by the Human Knee Joint During Activity[doctorate thesis]. Glasgow, United Kingdom: University of Strathclyde; 1969.
41.
Muellner T, Kaltenbrunner W, Nikolic A, Mittlboeck M, Schabus R, Vecsei V. Shortening of the patellar tendon after anterior cruciate ligament reconstruction. Arthroscopy. 1998;14:592-596.
42.
Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am. 1984;66:344-352.
43.
O'Brien SJ, Warren RF, Pavlov H, Panariello R, Wickiewicz TL. Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg Am. 1991;73:278-286.
44.
Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P. Infrapatellar contracture syndrome: an unrecognized cause of knee stiffness with patellar entrapment and patella infera. Am J Sports Med. 1987;15:331-341.
45.
Reider B, Marshall JL, Ring B. Patellar tracking. Clin Orthop Relat Res. 1981;157:143-148.
46.
Rosenberg TD, Franklin JL, Baldwin GN, Nelson KA. Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction. Am J Sports Med. 1992;20:519-526.
47.
Sachs RA, Daniel DM, Stone ML, Garfein RF. Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med. 1989;17:760-765.
48.
Sandmeier RH, Burks RT, Bachus KN, Billings A. The effect of reconstruction of the medial patellofemoral ligament on patellar tracking. Am J Sports Med. 2000;28:345-349.
49.
Seedhom BB, Hargreaves DJ. Transmission of the load in the knee joint with special reference to the role of the menisci, part II: experimental results, discussion and conclusions. Eng Med. 1979;8:220-228.
50.
Seedhom BB, Tsubuku M. A technique for the study of contact between visco-elastic bodies with special reference to the patellofemoral joint. J Biomech. 1977;10:253-260.
51.
Shaffer BS, Tibone JE. Patellar tendon length change after anterior cruciate ligament reconstruction using the midthird patellar tendon. Am J Sports Med. 1993;21:449-454.
52.
Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction: the effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991;19:332-336.
Van Eijden TMGJ, Kouwenhoven E, Verburg J, Weijs WA. A mathematical model of the patellofemoral joint. J Biomech. 1986;19:219-229.
55.
Van Eijden TMGJ, Kouwenhoven E, Weijs WA. Mechanics of the patellar articulation: effects of patellar ligament length studied with a mathematical model. Acta Orthop Scand. 1987;58:560-566.
56.
Van Kampen A, Huiskes R. The three-dimensional tracking pattern of the human patella. Clin Orthop Relat Res. 1990;8:372-382.
57.
Yao JQ, Seedhom BB. A new technique for measuring contact areas in human joints: the “3S technique.”Proc Inst Mech Eng. 1991;205:69-72.
