Reconstruction of the ACL with a Patellar Tendon Graft Based on the Infrapatellar Fat Pad: An Experimental Study in Animals

Abstract

The experimental groundwork for the present study was laid during the 1980s, when it was already generally known that the Mcintosh type of extraarticular cruciate ligament repair was of only short-term benefit, and that reconstruction of the anterior cruciate ligament (ACL) had to involve restoration of the central pivot. The Jones technique using a distally based strip of patellar tendon (Jones 1963) and the free patellar tendon graft (Bruckner 1972) were the procedures that we used most frequently. Now as before, there is no question that the patellar tendon is the material best suited for ACL replacement owing to its histomorphologic and biomechanical properties (Noyes and Butler 1984). The groups of Clancy (Clancy 1983) and Noyes (Paulos et al. 1983) have advocated a technique of maintaining vascularity to the patellar tendon graft by carefully preserving its attachment with the infrapatellar fat pad as a “vascular pedicle.” Following suitable dissection and mobilization, the vascularized patellar tendon graft can be transposed into the joint to function as an ACL substitute.