Shorter Relative Patellar Defect Length After Bone–Patellar Tendon–Bone Autograft Anterior Cruciate Ligament Reconstruction Is associated With Better Postoperative Patient‐Reported Outcomes at 1‐Year Follow‐Up

This is the authors' abstract. We don't add key points for this paper.

Purpose To evaluate bone–patellar tendon–bone autograft anterior cruciate ligament reconstruction patellar defect dimensions over time and associate these with patient‐reported outcomes. Methods Patients undergoing bone–patellar tendon–bone autograft autograft anterior cruciate ligament reconstruction by 1 of 7 surgeons between June 2020 and June 2023 were recruited to obtain knee magnetic resonance imaging at 6 weeks and 1 year postoperatively and complete a knee injury and osteoarthritis outcome score (KOOS) survey at 1 year postoperatively. Patellar bony defect dimensions relative to the entire patellar dimensions were measured on magnetic resonance imaging and associated with KOOSs at 1 year. Results For the 23 patients (15 men) with a mean ± standard deviation age 25.5 ± 5.2 analyzed, shorter relative patellar defect length at 6 weeks postoperatively was associated with better 1‐year KOOS activities of daily living ( R 2 = 0.481, P = .002) and function in sports and recreation ( R 2 = 0.436, P = .002), and showed trends for associating with better pain ( R 2 = 0.196, P = .078) and knee‐related quality of life ( R 2 = 0.222, P = .054). Participants with longer relative defects were more likely to report difficulty with kneeling ( R 2 = 0.278, P = .020). These associations were not altered by considering patient age or sex. The average relative patellar defect width and depth decreased from 6 weeks to 1 year ( P < .001), whereas relative defect length was unchanged. Intraobserver reliability was good to excellent for all measurements at 6 weeks and 1 year. Relative defect width and depth, at both 6 weeks and 1 year, had no significant associations with KOOSs at 1 year. Conclusions Shorter relative patellar defect length after bone–patellar tendon–bone autograft autograft anterior cruciate ligament reconstruction is associated with better patient‐reported outcome measures at 1 year, and thus, individual patient patellar size should be a consideration during graft harvest. Level of Evidence Level IV, retrospective case series.