1Associate professor of orthopedic surgery, Tabriz University of Medical Sciences
2Associate Professor,Road Traffic Injury Research Center, Tabriz University of Medical Sciences
Background: A potential specific problem of patellar tendon graft in ACL reconstruction is the possibility of graft-tunnel mismatch which could be more problematic with anatomic ACL reconstruction where the femoral tunnel is placed low on the lateral wall of the lateral femoral condyle. The occasional occurrence of this mismatch raises the question that whether a correlation exists between patient height and patellar tendon length. The purpose of the present study was to measure patellar tendon length as an anthropometric finding and to evaluate whether a correlation exists between patient height and patellar tendon length. Methods: Intra-operative measurement of patellar tendon length was carried out in 267 consecutive patients during bone-patellar tendon-bone (BTB) graft ACL reconstruction. Patient age, gender, height were recorded. The patellar tendon measurements were done independently by two surgeons and the possible inter-observer errors were checked. The data were analyzed using the Pearson correlation. Results: The mean length of the patellar tendon was 46.4 ± 4.8 mm (Mean ± SD) with a range of 32–61 mm. The mean patient height was 177 ± 7 cm (Mean ± SD) with a range of 159–197 cm. A weak positive correlations were found between patient height and patellar tendon length (Pearson r = 0.24, P< 0.001). The linear regression equation for patellar tendon length (y, in millimeters) as a function of patient height (x, in centimeters) can be expressed as y=16.54 + 0.17x. Conclusions: Our study showed a weak correlation between patellar tendon length and patient height. This finding is in contrast to the usual measurements in human anthropometry in which taller individuals have normally longer tendons and ligaments. The graft-tunnel mismatch may be the result of this variation.
Möller E, Weidenhielm L, Werner S. Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):786-94.
Shaffer B, Gow W, Tibone JE. Graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction: a new technique of intraarticular measurement and modified graft harvesting. Arthroscopy. 1993;9(6):633-46.
Augé II WK, Yifan K. Technical Note A Technique for Resolution of Graft-Tunnel Length Mismatch in Central Third Bone–Patellar Tendon–Bone Anterior Cruciate Ligament Reconstruction. Arthroscopy. 1999;15(8):877-81.
Denti M, Bigoni M, Randelli P, Monteleone M, Cevenini A, Ghezzi A, et al. Graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction Intraoperative and cadaver measurement of the intra-articular graft length and the length of the patellar tendon. Knee Surg Sports Traumatol Arthrosc. 1998;6(3):165-8.
Olszewski AD, Miller MD, Ritchie JR. Ideal tibial tunnel length for endoscopic anterior cruciate ligament reconstruction. Arthroscopy. 1998;14(1):9-14.
Taylor DE, Dervin GF, Keene GC. Femoral bone plug recession in endoscopic anterior cruciate ligament reconstruction. Arthroscopy. 1996;12(4):513-5.
Spindler K, Bergfeld J, Andrish J. Intraoperative complications of ACL surgery: avoidance and management. Orthopedics. 1993;16(4):425-30.
Verma NN, Dennis MG, Carreira DS, Bojchuk J, Hayden JK, Bach Jr BR. Preliminary clinical results of two techniques for addressing graft tunnel mismatch in endoscopic anterior cruciate ligament reconstruction. J Knee Surg. 2005;18(3):183-91.
Goldstein JL, Verma N, McNickle AG, Zelazny A, Ghodadra N, Bach BR. Avoiding mismatch in allograft anterior cruciate ligament reconstruction: correlation between patient height and patellar tendon length. Arthroscopy. 2010;26(5):643-50.
Verma N, Noerdlinger MA, Hallab N, Bush-Joseph CA, Bach BR. Effects of graft rotation on initial biomechanical failure characteristics of bone-patellar tendon-bone constructs. Am J Sports Med. 2003;31(5):708-13.
Fowler BL, DiStefano VJ. Tibial tunnel bone grafting: a new technique for dealing with graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction. Arthroscopy. 1998;14(2):224-8.
Mariani PP, Calvisi V, Margheritini F. A modified bone-tendon-bone harvesting technique for avoiding tibial tunnel–graft mismatch in anterior cruciate ligament reconstruction. Arthroscopy. 2003;19(1):3.
Grawe B, Smerina A, Allen A. Avoiding Graft-Tunnel Length Mismatch in Anterior Cruciate Ligament Reconstruction: The Single–Bone Plug Technique. Arthrosc Tech. 2014;3(3):417-20.
Wang H, Hua C, Cui H, Li Y, Qin H, Han D, et al. Measurement of normal patellar ligament and anterior cruciate ligament by MRI and data analysis. Exp Ther Med. 2013; 5(3):917-921.
Brown JA, Brophy RH, Franco J, Marquand A, Solomon TC, Watanabe D, et al. Avoiding Allograft Length Mismatch During Anterior Cruciate Ligament Reconstruction Patient Height as an Indicator of Appropriate Graft Length. Am J Sports Med. 2007; 35(6):986-9.
Luk KM, Wong N, Cheng JC. Anthropometry of the patellar tendon in Chinese. J Orthop Surg (Hong Kong). 2008;16(1):39-42.
Couppé C, Svensson RB, Sødring-Elbrønd V, Hansen P, Kjær M, Magnusson SP. Accuracy of MRI technique in measuring tendon cross-sectional area. Clin Physiol Funct Imaging. 2014;34(3):237-41.