Partan Matthew J, Nayak Raghunandan, Patel Rohan, Korabelnikov Tomer, DeManche Alyssa, Obopilwe Elifho, Arciero Robert A, Edgar Cory M, Coyner Katherine J
Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.
Institute for Sports Medicine, University of Connecticut, Storrs, Connecticut, U.S.A.
Arthrosc Sports Med Rehabil. 2025 Jun 13;7(4):101203. doi: 10.1016/j.asmr.2025.101203. eCollection 2025 Aug.
To biomechanically assess the impact of different patellar defect sizes on the ultimate load to failure (ULTF) and fracture risk immediately after bone-patellar tendon-bone harvest.
Twelve fresh-frozen mid femur to mid tibia-fibula cadaveric specimens (8 female specimens) with an average age of 75 years (range, 64-88 years) were randomly assigned to a defect length of 20 or 25 mm. A triangular wedge bone block was harvested from the patella, and the defect was measured. The extensor mechanism was loaded until failure with the knee in 30° of flexion. ULTF and failure modes were recorded. Statistical analyses were performed between the 2 groups to identify significance ( < .05).
Analyses were performed on 10 specimens because 2 were excluded. The average ULTF was not significantly different between the 20- and 25-mm groups (2,313 ± 863 N and 2,443 ± 839 N, respectively; = .815) despite a significantly different percentage of total patellar defect length between the 2 groups (39.5% ± 3.9% and 49.1% ± 4.1%, respectively; = .005). In 7 specimens, the first point of bony failure was at the patella, whereas in the remaining 3 specimens, it was distal to the patella.
The results of this biomechanical study show that up to a 25-mm-long patellar bone block harvest can be performed safely with a low risk of patellar fracture.
There is concern for complications including an increased risk of patellar fracture at the harvest site after bone-patellar tendon-bone autograft harvest. The risk of this complication based on patellar harvest size is not well understood. This study provides biomechanical insights into assessing fracture risk of patellar harvest between 20 and 25 mm in length.
从生物力学角度评估不同大小的髌骨缺损对取骨-髌腱-骨后即刻的极限破坏载荷（ULTF）及骨折风险的影响。
选取12个新鲜冷冻的股骨中段至胫腓骨中段尸体标本（8个女性标本），平均年龄75岁（范围64 - 88岁），随机分为缺损长度为20或25毫米的两组。从髌骨获取一个三角形楔形骨块，并测量缺损情况。在膝关节屈曲30°状态下对伸膝装置加载直至破坏。记录ULTF及破坏模式。对两组进行统计学分析以确定显著性差异（P <.05）。
因排除2个标本，对10个标本进行了分析。20毫米组和25毫米组的平均ULTF无显著差异（分别为2313 ± 863牛和2443 ± 839牛；P =.815），尽管两组间髌骨缺损总长度的百分比差异显著（分别为39.5% ± 3.9%和49.1% ± 4.1%；P =.005）。7个标本中，首次骨破坏点在髌骨，而其余3个标本中，破坏点在髌骨远端。
这项生物力学研究结果表明，安全获取长达25毫米的髌骨骨块时，髌骨骨折风险较低。
对于自体骨-髌腱-骨移植后取骨部位包括髌骨骨折风险增加等并发症存在担忧。基于髌骨取骨大小的该并发症风险尚不清楚。本研究为评估20至25毫米长度的髌骨取骨骨折风险提供了生物力学见解。
