Incidence and patient-reported outcomes of patella fractures following bone-patellar tendon-bone autograft anterior cruciate ligament reconstruction: a propensity-matched Cohort analysis.

Abstract

ACL tears are among the most common injuries in active individuals, with Bone-Patellar Tendon-Bone (BTB) autograft being the gold-standard treatment for reconstruction. Despite excellent outcomes, complications such as patella fractures, reported as high as 1.8%, remain a concern. This study aimed to update the incidence of patella fractures after BTB ACL reconstruction at a high-volume center and compare patient outcomes with isolated ACL rupture or patella fracture. We hypothesized a lower incidence than previously reported and comparable post-operative outcomes across groups. We retrospectively reviewed patients undergoing BTB ACL reconstruction (2012-2022) who sustained harvest site patella fractures. Cases were 2:1 propensity score-matched with patients having isolated ACL rupture or patella fracture. Inclusion criteria were age > 18, ≥ 1-year follow-up, and post-op patella fracture diagnosis. Data collected included demographics, surgical details, bone plug dimensions, and patient-reported outcomes (Lysholm, IKDC, Tegner Activity Scale). Treatment strategies and healing outcomes for patella fractures were also recorded. Among 5770 BTB ACL reconstructions, 12 patients (0.21%) sustained post-op patella fractures. They were matched to 24 with isolated ACL rupture and 24 with patella fracture. Average follow-up was 6.4 years. Pre-op scores demonstrated significant differences: ACL + patella fracture group had lower Lysholm (62.8), IKDC (48.1), and Tegner scores (7.1) compared to isolated ACLR and patella fracture groups. Post-op scores in the ACL + patella fracture group improved significantly (Lysholm 84.4, IKDC 72.0). Patella fracture incidence after BTB ACL reconstruction is lower than previously reported (0.21%). Patients with this complication still achieve excellent outcomes comparable to those with isolated ACL or patella injuries.