Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2016

22.01.2015 | Knee

Quantitative assessment of patellar vascularity following bone-patellar tendon-bone autograft harvest for ACL reconstruction

verfasst von: Kristofer J. Jones, Lionel E. Lazaro, Samuel A. Taylor, Nadine C. Pardee, Jonathan P. Dyke, Jo A. Hannafin, Russell F. Warren, Dean G. Lorich

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 9/2016

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Recent anatomic studies have suggested that the dominant arterial supply of the patella enters through the inferior pole. Based upon these findings, we hypothesized that bone-patellar tendon-bone graft harvest can significantly diminish patellar vascularity.

Methods

Nine matched pair cadaveric knee specimens (mean age 47.4 years) were dissected and cannulated. A single knee was selected to undergo routine graft harvest, and the contralateral knee was left intact to serve as a control. Gadolinium was injected, and magnetic resonance imaging (MRI) signal enhancement was quantified to determine differences in uptake. Each matched pair was subsequently injected with a urethane polymer compound and dissected to correlate vessel disruption with MRI findings.

Results

We identified two predominating patterns of vessel entry. In one pattern, the vessel entered the inferomedial aspect (five o’clock/right, seven o’clock/left) of the patella and was disrupted by graft harvest in 2/9 (22.2 %) pairs. In the second pattern, the vessel entered further medial (four o’clock/right, eight o’clock/left) and was not disrupted (7/9, 78.8 %). The mean decrease in gadolinium uptake following disruption of the predominant vessel measured 56.2 % (range 42.6–69.5 %) compared to an average decrease of 18.3 % (range 7.1–29.1 %) when the dominant arterial supply to the inferior pole remained intact (p < 0.04).

Conclusion

Medial entry of the predominant vessel precluded vessel disruption. Disruption of the dominant arterial supply can result in a significant decrease in patellar vascularity. Modification of graft harvest techniques and areas of surgical dissection should be explored to minimize vascular insult. Further correlation with clinical studies/outcomes is necessary to determine a potential association between vascular insult and anterior knee pain.
Literatur
1.
Zurück zum Zitat Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ, Allen AA (2010) Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med 38(2):281–286CrossRefPubMed Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ, Allen AA (2010) Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med 38(2):281–286CrossRefPubMed
2.
Zurück zum Zitat Beaufils P, Gaudot F, Drain O, Boisrenoult P, Pujol N (2011) Mini-invasive technique for bone patellar tendon bone harvesting: its superiority in reducing anterior knee pain following ACL reconstruction. Curr Rev Musculoskelet Med 4:45–51CrossRefPubMedPubMedCentral Beaufils P, Gaudot F, Drain O, Boisrenoult P, Pujol N (2011) Mini-invasive technique for bone patellar tendon bone harvesting: its superiority in reducing anterior knee pain following ACL reconstruction. Curr Rev Musculoskelet Med 4:45–51CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Biau DJ, Katcahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, Ejerhed L, Zaffagnini S, Ropke M, Nizard R (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 37(12):2470–2478CrossRefPubMed Biau DJ, Katcahian S, Kartus J, Harilainen A, Feller JA, Sajovic M, Ejerhed L, Zaffagnini S, Ropke M, Nizard R (2009) Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med 37(12):2470–2478CrossRefPubMed
4.
Zurück zum Zitat Bjorkstrom S, Goldie IF (1980) A study of the arterial supply of the patella in the normal state, in chondromalacia patellae and in osteoarthrosis. Acta Orthop Scand 51(1):63–70CrossRefPubMed Bjorkstrom S, Goldie IF (1980) A study of the arterial supply of the patella in the normal state, in chondromalacia patellae and in osteoarthrosis. Acta Orthop Scand 51(1):63–70CrossRefPubMed
5.
Zurück zum Zitat Boraiah S, Dyke JP, Hettrich C, Parker RJ, Miller A, Helfet D, Lorich D (2009) Assessment of vascularity of the femoral head using gadolinium (Gd-DTPA) enhanced magnetic resonance imaging: a cadaver study. J Bone Joint Surg Br 91(1):131–137CrossRefPubMed Boraiah S, Dyke JP, Hettrich C, Parker RJ, Miller A, Helfet D, Lorich D (2009) Assessment of vascularity of the femoral head using gadolinium (Gd-DTPA) enhanced magnetic resonance imaging: a cadaver study. J Bone Joint Surg Br 91(1):131–137CrossRefPubMed
6.
Zurück zum Zitat Brand J Jr, Weiler A, Caborn DN, Brown CH, Johnson DL (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28(5):761–764PubMed Brand J Jr, Weiler A, Caborn DN, Brown CH, Johnson DL (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28(5):761–764PubMed
7.
Zurück zum Zitat Brown CH, Hecker AT, Hipp JA, Myers ER, Hayes WC (1993) The biomechanics of interference screw fixation of patellar tendon anterior cruciate ligament grafts. Am J Sports Med 21(6):880–886CrossRefPubMed Brown CH, Hecker AT, Hipp JA, Myers ER, Hayes WC (1993) The biomechanics of interference screw fixation of patellar tendon anterior cruciate ligament grafts. Am J Sports Med 21(6):880–886CrossRefPubMed
8.
Zurück zum Zitat Cheung SC, Allen CR, Gallo RA, Ma CB, Feeley BT (2012) Patients’ attitudes and factors in their selection of grafts for anterior cruciate ligament reconstruction. Knee 19(1):49–54CrossRefPubMed Cheung SC, Allen CR, Gallo RA, Ma CB, Feeley BT (2012) Patients’ attitudes and factors in their selection of grafts for anterior cruciate ligament reconstruction. Knee 19(1):49–54CrossRefPubMed
9.
Zurück zum Zitat Cohen SB, Yucha DT, Ciccotti MC, Goldstein DT, Ciccotti MA, Ciccotti MG (2009) Factors affecting patient selection of graft type in anterior cruciate ligament reconstruction. Arthroscopy 25(9):1006–1010CrossRefPubMed Cohen SB, Yucha DT, Ciccotti MC, Goldstein DT, Ciccotti MA, Ciccotti MG (2009) Factors affecting patient selection of graft type in anterior cruciate ligament reconstruction. Arthroscopy 25(9):1006–1010CrossRefPubMed
10.
Zurück zum Zitat Poehling GG, Curl WW, Lee CA, Ginn TA, Rushing JT, Naughton MJ, Holden MB, Martin DF, Smith BP (2005) Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft. Arthroscopy 21(7):774–785CrossRefPubMed Poehling GG, Curl WW, Lee CA, Ginn TA, Rushing JT, Naughton MJ, Holden MB, Martin DF, Smith BP (2005) Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft. Arthroscopy 21(7):774–785CrossRefPubMed
11.
Zurück zum Zitat Dunn WR, Lyman S, Lincoln AE, Amoroso PJ, Wickiewicz T, Marx RG (2004) The effect of anterior cruciate ligament reconstruction on the risk of knee reinjury. Am J Sports Med 32:1906–1914CrossRefPubMed Dunn WR, Lyman S, Lincoln AE, Amoroso PJ, Wickiewicz T, Marx RG (2004) The effect of anterior cruciate ligament reconstruction on the risk of knee reinjury. Am J Sports Med 32:1906–1914CrossRefPubMed
12.
Zurück zum Zitat Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11PubMed Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11PubMed
13.
Zurück zum Zitat Gelfer Y, Pinkas L, Halperin N, Alk D, Robinson D (2003) Symptomatic transient patellar ischemia following total knee replacement as detected by scintigraphy: a prospective, randomized, double blind-study comparing the mid-vastus to the medial para-patellar approach. Knee 10:341–345CrossRefPubMed Gelfer Y, Pinkas L, Halperin N, Alk D, Robinson D (2003) Symptomatic transient patellar ischemia following total knee replacement as detected by scintigraphy: a prospective, randomized, double blind-study comparing the mid-vastus to the medial para-patellar approach. Knee 10:341–345CrossRefPubMed
14.
Zurück zum Zitat Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L (2012) Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconsruction registry comparison between Norway and the USA. Acta Orthop 83(6):577–582CrossRefPubMedPubMedCentral Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L (2012) Intraoperative findings and procedures in culturally and geographically different patient and surgeon populations: an anterior cruciate ligament reconsruction registry comparison between Norway and the USA. Acta Orthop 83(6):577–582CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Hettrich CM, Boraiah S, Dyke JP, Neviaser A, Helfet DL, Lorich DG (2010) Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am 92(4):943–948CrossRefPubMed Hettrich CM, Boraiah S, Dyke JP, Neviaser A, Helfet DL, Lorich DG (2010) Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am 92(4):943–948CrossRefPubMed
16.
Zurück zum Zitat Inacio M, Paxton EW, Maletis GB, Csintalan RP, Granan LP, Fithian DC, Funahashi TT (2012) Patient and surgeon characteristics associated with primary anterior cruciate ligament reconstruction graft selection. Am J Sports Med 40(2):339–345CrossRefPubMed Inacio M, Paxton EW, Maletis GB, Csintalan RP, Granan LP, Fithian DC, Funahashi TT (2012) Patient and surgeon characteristics associated with primary anterior cruciate ligament reconstruction graft selection. Am J Sports Med 40(2):339–345CrossRefPubMed
17.
Zurück zum Zitat Irrgang JJ, Harner CD (1995) Loss of motion following knee ligament reconstruction. Sports Med 19:150–159CrossRefPubMed Irrgang JJ, Harner CD (1995) Loss of motion following knee ligament reconstruction. Sports Med 19:150–159CrossRefPubMed
18.
Zurück zum Zitat Jackson DW, Schaefer RK (1990) Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 6:171–178CrossRefPubMed Jackson DW, Schaefer RK (1990) Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 6:171–178CrossRefPubMed
19.
Zurück zum Zitat Jones KG (1963) Reconstruction of the anterior cruciate ligament: a technique using the central one-third of the patellar ligament. J Bone Joint Surg Am 45A(5):925–932 Jones KG (1963) Reconstruction of the anterior cruciate ligament: a technique using the central one-third of the patellar ligament. J Bone Joint Surg Am 45A(5):925–932
20.
Zurück zum Zitat Kapoor B, Clement DJ, Kirkley A, Maffulli N (2004) Current practice in the management of anterior cruciate ligament injuries in the United Kingdom. Br J Sports Med 38:542–544CrossRefPubMedPubMedCentral Kapoor B, Clement DJ, Kirkley A, Maffulli N (2004) Current practice in the management of anterior cruciate ligament injuries in the United Kingdom. Br J Sports Med 38:542–544CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction: a 2–5 year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7:2–8CrossRefPubMed Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction: a 2–5 year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7:2–8CrossRefPubMed
22.
Zurück zum Zitat Kartus J, Stener S, Lindahl S, Engstrom B, Eriksson BI, Karlsson J (1997) Factors affecting donor-site morbidity after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. Knee Surg Sports Traumatol Arthrosc 5:222–228CrossRefPubMed Kartus J, Stener S, Lindahl S, Engstrom B, Eriksson BI, Karlsson J (1997) Factors affecting donor-site morbidity after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. Knee Surg Sports Traumatol Arthrosc 5:222–228CrossRefPubMed
23.
Zurück zum Zitat Kleipool AE, van Loon T, Marti RK (1994) Pain after use of the central third of the patellar tendon for cruciate ligament reconstruction: 33 patients followed 2–3 years. Acta Orthop Scand 65(1):62–66CrossRefPubMed Kleipool AE, van Loon T, Marti RK (1994) Pain after use of the central third of the patellar tendon for cruciate ligament reconstruction: 33 patients followed 2–3 years. Acta Orthop Scand 65(1):62–66CrossRefPubMed
24.
Zurück zum Zitat Kohl S, Evangelopoulos DS, Hartel M, Kohlhof H, Roeder C, Eggli S (2011) Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow. Knee Surg Sports Traumatol Arthrosc 19:1453–1459CrossRefPubMed Kohl S, Evangelopoulos DS, Hartel M, Kohlhof H, Roeder C, Eggli S (2011) Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow. Knee Surg Sports Traumatol Arthrosc 19:1453–1459CrossRefPubMed
25.
Zurück zum Zitat Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15(3):225–229CrossRefPubMed Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15(3):225–229CrossRefPubMed
26.
Zurück zum Zitat Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J (2005) A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy 21(1):34–42CrossRefPubMed Laxdal G, Kartus J, Hansson L, Heidvall M, Ejerhed L, Karlsson J (2005) A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy 21(1):34–42CrossRefPubMed
27.
Zurück zum Zitat Lazaro LE, Wellman DS, Klinger CE, Dyke JP, Pardee NC, Sculco PK, Berkes MB, Helfet DL, Lorich DG (2013) Quantitative and qualitative assessment of bone perfusion and arterial contributions in a patellar fracture model using gadolinium-enhanced magnetic resonance imaging: a cadaveric study. J Bone Joint Surg Am 95(19):1401–1407CrossRef Lazaro LE, Wellman DS, Klinger CE, Dyke JP, Pardee NC, Sculco PK, Berkes MB, Helfet DL, Lorich DG (2013) Quantitative and qualitative assessment of bone perfusion and arterial contributions in a patellar fracture model using gadolinium-enhanced magnetic resonance imaging: a cadaveric study. J Bone Joint Surg Am 95(19):1401–1407CrossRef
28.
Zurück zum Zitat Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 91:2321–2328CrossRefPubMed Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 91:2321–2328CrossRefPubMed
29.
Zurück zum Zitat Marx RG, Jones EC, Angel M, Wickiewicz TL, Warren RF (2003) Beliefs and attitudes of members of the America Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Arthroscopy 19(7):762–770CrossRefPubMed Marx RG, Jones EC, Angel M, Wickiewicz TL, Warren RF (2003) Beliefs and attitudes of members of the America Academy of Orthopaedic Surgeons regarding the treatment of anterior cruciate ligament injury. Arthroscopy 19(7):762–770CrossRefPubMed
30.
Zurück zum Zitat Miller AN, Prasarn ML, Dyke JP, Helfet DL, Lorich DG (2011) Quantitative assessment of the vascularity of the talus with gadolinium-enhanced magnetic resonance imaging. J Bone Joint Surg Am 93(12):1116–1121CrossRefPubMed Miller AN, Prasarn ML, Dyke JP, Helfet DL, Lorich DG (2011) Quantitative assessment of the vascularity of the talus with gadolinium-enhanced magnetic resonance imaging. J Bone Joint Surg Am 93(12):1116–1121CrossRefPubMed
31.
Zurück zum Zitat Muellner T, Kaltenbrunner W, Nikolic A, Mittlboeck M, Schabus R, Vecsei V (1998) Shortening of the patellar tendon after anterior cruciate ligament reconstruction. Arthroscopy 14(6):592–596CrossRefPubMed Muellner T, Kaltenbrunner W, Nikolic A, Mittlboeck M, Schabus R, Vecsei V (1998) Shortening of the patellar tendon after anterior cruciate ligament reconstruction. Arthroscopy 14(6):592–596CrossRefPubMed
32.
Zurück zum Zitat Niki Y, Hakozaki A, Iwamoto W, Kanagawa H, Matsumoto H, Toyama Y, Suda Y (2012) Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Traumatol Arthrosc 20:1543–1549CrossRef Niki Y, Hakozaki A, Iwamoto W, Kanagawa H, Matsumoto H, Toyama Y, Suda Y (2012) Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction. Knee Surg Traumatol Arthrosc 20:1543–1549CrossRef
33.
Zurück zum Zitat Pakos E, Ntzani E, Trikalinos T (2005) Patellar resurfacing in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 87:1438–1445CrossRefPubMed Pakos E, Ntzani E, Trikalinos T (2005) Patellar resurfacing in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 87:1438–1445CrossRefPubMed
34.
Zurück zum Zitat Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M (2014) Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the Danish registry of knee ligament reconstruction. Am J Sports Med 42(2):278–284CrossRefPubMed Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M (2014) Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: results from the Danish registry of knee ligament reconstruction. Am J Sports Med 42(2):278–284CrossRefPubMed
35.
Zurück zum Zitat Sachs RA, Daniel DM, Stone ML, Garfein RF (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760–765CrossRefPubMed Sachs RA, Daniel DM, Stone ML, Garfein RF (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760–765CrossRefPubMed
36.
Zurück zum Zitat Scapinelli R (1967) Blood supply of the human patella: its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 49(3):563–570PubMed Scapinelli R (1967) Blood supply of the human patella: its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br 49(3):563–570PubMed
37.
Zurück zum Zitat Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30(2):214–220PubMed Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30(2):214–220PubMed
38.
Zurück zum Zitat Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18:292–299CrossRefPubMed Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18:292–299CrossRefPubMed
39.
Zurück zum Zitat Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25:41–47CrossRefPubMed Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25:41–47CrossRefPubMed
40.
Zurück zum Zitat Steiner ME, Hecker AT, Brown CH, Hayes WC (1994) Anterior cruciate ligament graft fixation: comparison of hamstring and patellar tendon grafts. Am J Sports Med 22(2):240–246CrossRefPubMed Steiner ME, Hecker AT, Brown CH, Hayes WC (1994) Anterior cruciate ligament graft fixation: comparison of hamstring and patellar tendon grafts. Am J Sports Med 22(2):240–246CrossRefPubMed
41.
Zurück zum Zitat Tsuda E, Okamura Y, Ishibashi Y, Otsuka H, Toh S (2001) Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Am J Sports Med 29(4):450–456PubMed Tsuda E, Okamura Y, Ishibashi Y, Otsuka H, Toh S (2001) Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft. Am J Sports Med 29(4):450–456PubMed
42.
Zurück zum Zitat Yunes M, Richmond JC, Engels EA, Pinczewski LA (2001) Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy 17:248–257CrossRefPubMed Yunes M, Richmond JC, Engels EA, Pinczewski LA (2001) Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy 17:248–257CrossRefPubMed
Metadaten
Titel
Quantitative assessment of patellar vascularity following bone-patellar tendon-bone autograft harvest for ACL reconstruction
verfasst von
Kristofer J. Jones
Lionel E. Lazaro
Samuel A. Taylor
Nadine C. Pardee
Jonathan P. Dyke
Jo A. Hannafin
Russell F. Warren
Dean G. Lorich
Publikationsdatum
22.01.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 9/2016
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3510-2

Weitere Artikel der Ausgabe 9/2016

Knee Surgery, Sports Traumatology, Arthroscopy 9/2016 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.