Bone Grafting the Patellar Defect following BPTB ACL Reconstruction Decreases Anterior Knee Morbidity: A Systematic Review.

Abstract

PURPOSE\nThe aim of this systematic review is to evaluate the impact of bone grafting the patellar defect on reported anterior knee morbidity and subjective outcomes following bone-patellar tendon-bone autograft reconstruction of the anterior cruciate ligament.\n\n\nMETHODS\nA systematic electronic search of MEDLINE, EMBASE, Web of Science, and the Cochrane Library was carried out. All English-language prospective randomized clinical trials published from January 1, 2000 to July 24, 2020 were eligible for inclusion. All papers addressing patella defect grafting were eligible for inclusion regardless of the timing of surgery, graft type, surgical technique, or rehabilitation.\n\n\nRESULTS\nA total of 39 studies with 1,955 patients were included for analysis. There were 796 patients in the no patella grafting (NPG) group with a mean age range of 22.7 to 33.0 years, and 1,159 patients in the patella grafting (PG) group with a mean age range of 17.8 to 34.7 years. The VAS pain score ranged from 1.2 to 5.1 in the NPG group compared to 0.3 to 3.7 in the PG group. The proportion of anterior knee pain in the NPG group ranged from 19% to 81%, and from 15% to 32% in the PG group. Moderate to severe kneeling pain was reported in 22% to 57% of patients within the NPG group, and in 10% of patients in the PG group. The percentage of patients with ≥ 3° of extension loss ranged from 4% to 43% in the NPG group, and ranged from 2% to 11% in the PG group.\n\n\nCONCLUSION\nPatellar grafting favors decreased anterior knee pain, kneeling pain, and extension loss compared to non-grafted defects, however there are comparable functional outcomes. Due to the heterogeneity in reporting, statistical conclusions could not be drawn.