Lezak Bradley A, Mercer Nathaniel P, Chen Larry, Lashgari Alex, Jazrawi Laith, Egol Kenneth
New York University Langone Orthopedic Hospital, New York, USA.
Eur J Orthop Surg Traumatol. 2025 Aug 7;35(1):340. doi: 10.1007/s00590-025-04422-1.
ACL tears are among the most common injuries in active individuals, with Bone-Patellar Tendon-Bone (BTB) autograft being the gold-standard treatment for reconstruction. Despite excellent outcomes, complications such as patella fractures, reported as high as 1.8%, remain a concern. This study aimed to update the incidence of patella fractures after BTB ACL reconstruction at a high-volume center and compare patient outcomes with isolated ACL rupture or patella fracture. We hypothesized a lower incidence than previously reported and comparable post-operative outcomes across groups.
We retrospectively reviewed patients undergoing BTB ACL reconstruction (2012-2022) who sustained harvest site patella fractures. Cases were 2:1 propensity score-matched with patients having isolated ACL rupture or patella fracture. Inclusion criteria were age > 18, ≥ 1-year follow-up, and post-op patella fracture diagnosis. Data collected included demographics, surgical details, bone plug dimensions, and patient-reported outcomes (Lysholm, IKDC, Tegner Activity Scale). Treatment strategies and healing outcomes for patella fractures were also recorded.
Among 5770 BTB ACL reconstructions, 12 patients (0.21%) sustained post-op patella fractures. They were matched to 24 with isolated ACL rupture and 24 with patella fracture. Average follow-up was 6.4 years. Pre-op scores demonstrated significant differences: ACL + patella fracture group had lower Lysholm (62.8), IKDC (48.1), and Tegner scores (7.1) compared to isolated ACLR and patella fracture groups. Post-op scores in the ACL + patella fracture group improved significantly (Lysholm 84.4, IKDC 72.0).
Patella fracture incidence after BTB ACL reconstruction is lower than previously reported (0.21%). Patients with this complication still achieve excellent outcomes comparable to those with isolated ACL or patella injuries.
前交叉韧带（ACL）撕裂是活跃人群中最常见的损伤之一，骨-髌腱-骨（BTB）自体移植是重建手术的金标准治疗方法。尽管治疗效果良好，但髌骨骨折等并发症（报告发生率高达1.8%）仍然是一个令人担忧的问题。本研究旨在更新一家大型中心BTB ACL重建术后髌骨骨折的发生率，并比较患者与单纯ACL撕裂或髌骨骨折患者的预后情况。我们假设其发生率低于先前报告的水平，且各组术后预后情况相当。
我们回顾性分析了2012年至2022年期间接受BTB ACL重建且发生取骨部位髌骨骨折的患者。病例按2:1倾向评分匹配单纯ACL撕裂或髌骨骨折的患者。纳入标准为年龄>18岁、随访≥1年以及术后髌骨骨折诊断。收集的数据包括人口统计学资料、手术细节、骨栓尺寸以及患者报告的预后情况（Lysholm评分、国际膝关节文献委员会（IKDC）评分、Tegner活动量表）。还记录了髌骨骨折的治疗策略和愈合情况。
在5770例BTB ACL重建手术中，12例患者（0.21%）术后发生髌骨骨折。将他们与24例单纯ACL撕裂患者和24例髌骨骨折患者进行匹配。平均随访时间为6.4年。术前评分显示出显著差异：与单纯ACL重建和髌骨骨折组相比，ACL撕裂合并髌骨骨折组的Lysholm评分（62.8）、IKDC评分（48.1）和Tegner评分（7.1）更低。ACL撕裂合并髌骨骨折组术后评分显著改善（Lysholm评分84.4，IKDC评分72.0）。
BTB ACL重建术后髌骨骨折的发生率低于先前报告（0.21%）。发生这种并发症的患者仍能取得与单纯ACL损伤或髌骨损伤患者相当的良好预后。
