Refilling of removal defects:: Impact on extensor mechanism complaints after use of a bone-tendon-bone graft for anterior cruciate ligament reconstruction

In a prospective study, the impact of refilling removal defects at the tibial tuberosity and patella on extensor mechanism complaints was studied after anterior cruciate ligament reconstruction with a bone-tendon-bone ligament graft. A conventional cannulated drill was sued in patients of group 1 (n = 62), and an oscillating hollow saw was used in group 2 (n = 70) for drilling and removing bone material from the tibial tunnel. On completing the procedure in the patients in group 2, the bone material removed was inserted into the bony removal defects at the tibial tuberosity and the patella. In both groups, the extensor mechanism was closed using loose sutures. Both groups underwent the same postoperative therapy regimen. All patients underwent clinical and radiographic follow-up after approximately 34 months. In this follow-up, no differences with regard to knee function as assessed by the IKDC rating scale and KT-1000 measurements were found between the 2 groups. The rate of mild to severe patellofemoral complaints was 31% (41 patients). Complaints related to the removal defects as assessed by kneeling and squatting on the operated knee were described by 25 patients (18.9%), No significant difference between the groups with and without refilling of the removal defects was observed, and the overall subjective ratings on a visual analogs scale (VAS) (0 = no pain, 10 = severe pain) for kneeling and squatting were 5.57 and 3.69, respectively. Follow-up time was identified as the critical parameter for problems related to the extensor mechanism, such as complaints in kneeling and squatting, with hardly any problems observed after 2 years. On the other hand, anterior knee pain correlated significantly with the residual limitation of motion.