Bone-Albumin filling decreases donor site morbidity and enhances bone formation after anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts

• Published in: International orthopaedics Vol. 40; no. 10; pp. 2097 - 2104
• Main Authors: Schandl, Károly, Horváthy, Dénes B., Doros, Attila, Majzik, Ernő, Schwarz, Charlotte M., Csönge, Lajos, Abkarovits, Géza, Bucsi, László, Lacza, Zsombor
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2016
• Subjects: Adult; Albumins - administration & dosage; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - methods; Autografts; Bone Transplantation; Bone-Patellar Tendon-Bone Grafting - methods; Female; Humans; Knee Joint - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Osteogenesis - physiology; Tibia - physiopathology; Tibia - surgery; Transplant Donor Site - physiopathology; Transplant Donor Site - surgery; Transplantation, Autologous; Transplantation, Homologous; BTB; Albumin; Serum; Bone-tendon-bone; Bone allograft; Bone-Albumin; Anterior cruciate ligament
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-016-3246-8

Purpose Donor site pain affects 32–43 % of patients after anterior cruciate ligament surgery when the autograft is freshly harvested bone-patellar tendon-bone tissue. Our aim was to compare functional and morphological differences between donor sites with and without serum albumin-coated bone allograft filling. Methods After harvesting and implanting the graft, the tibia site was filled with either fresh autologous cancellous bone enhanced with albumin-coated allograft or autologous bone alone. The patella site was filled either with albumin-coated allograft or with blood clot. Knee function was evaluated by the VISA, Lysholm and IKDC scores and a visual analog scale of pain during standing, kneeling and crouching after six weeks and six months. Computed tomography was performed at six months for morphological evaluation. Results At six weeks, both groups were still recovering from surgery and the overall knee function was still impaired but the functional scores were significantly higher in the Bone-Albumin group. The pain with crouching and kneeling was also lower as compared to controls. At six months, the knee function scores were close to normal, with a slight decrease in the controls. Pain at kneeling was still prominent in the controls, but significantly lower in the Bone-Albumin group. Computed tomography showed significantly smaller bone defects and higher bone density in the Bone-Albumin group. Conclusions Results from the present study indicate that donor site pain, a disturbing long-term side effect of bone-patellar tendon-bone surgery, is significantly reduced if bone buildup in the patella and the tibia is augmented by serum albumin-coated bone allografts.