Does Bone Grafting at the Time of Bone-Patellar Tendon-Bone ACL Reconstruction Reduce the Incidence of Post-operative Anterior Knee Pain: A Randomized Controlled Clinical Study

NCT ID: NCT04958733

Last Updated: 2022-08-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-09-03

Study Completion Date

2024-06-30

Brief Summary

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It is estimated that 48 out of 10,000 people, in the United States, will tear their anterior cruciate ligament (ACL) annually and undergo ACL reconstruction (ACLR). Surgeons have several graft options, surgical techniques, and fixation methods to consider when planning how to reconstruct a patient's ACL. Graft options vary greatly and include allografts and autografts with good evidence that are good choices. Further, autografts include several different specific grafts including; bone-patellar tendon-bone (BPTB), hamstring tendons, and quadriceps tendon. There is no clear consensus on which graft type is superior, as each graft has associated positives and negatives.

Historically, autologous BPTB grafts have been the preferred choice of surgeons given its ability to restore rotational stability for the knee, the robust healing with direct bone-to-bone contact at both ends of the graft, and low failure rates. However, there are drawbacks to ACLR using a BPTB graft. Complications following BPTB graft harvesting include patella fractures, patellar tendon ruptures, increased risk of patellofemoral osteoarthritis, lack of terminal extension, and donor-site morbidity. The majority of these complications are associated with low-risk rates, except for donor-site morbidity which may be prevalent in 37-51% of BPTB graft patients. Donor-site pain can manifest as anterior knee, patellofemoral pain, loss of sensory input, or discomfort with kneeling and can negatively influence subjective as well as objective measures of knee function.

Filling bony defects with bone graft is a procedure that is commonly conducted within orthopedics. However, its use in treating the bony defects caused during BPTB graft harvesting is less common as patella and tibial harvest sites are routinely left unfilled. Significant methodological differences in treatment interventions for the patella harvest site, the tibial harvest site, or both and conflicting results have made it difficult to determine if these treatments have clinical utility. To the best of the investigators' knowledge, there has been no investigation looking at the incidence of donor site morbidity treated with autologous bone grafting of the harvest sites. Therefore, the purpose of this study is to determine if filling the harvest site defect is associated with a lower rate of donor site morbidity and better patient reported functional outcomes compared to patients whose harvest site remains unfilled.

The purpose of this study is to compare the rate of donor site morbidity between patients who have their harvest sites bone grafted with autologous bone (BG) and those whose harvest sites remain unfilled (nBG).

Detailed Description

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Conditions

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ACL Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Autologous Bone Grafting

Excess bone obtained from graft preparation and the coring reamer will be used to fill the patellar and tibial donor sites.

Group Type ACTIVE_COMPARATOR

Autologous bone grafting

Intervention Type PROCEDURE

Autologous bone grafting is the excess bone obtained from graft preparation and the coring reamer

Control

The control group will have their patellar and tibial defects remain unfilled.

Group Type PLACEBO_COMPARATOR

Absence of autologous bone grafting

Intervention Type PROCEDURE

Donor sites will be left unfilled

Interventions

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Autologous bone grafting

Autologous bone grafting is the excess bone obtained from graft preparation and the coring reamer

Intervention Type PROCEDURE

Absence of autologous bone grafting

Donor sites will be left unfilled

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Males and females
* 18 years of age and older, with no upper age limit
* A candidate for primary autologous BPTB ACLR
* Willing to participate in the study

Exclusion Criteria

* Concomitant ligamentous or chondral injury
* Prior surgery on the index knee
* Prior history of anterior knee pain or patellofemoral joint pain on the index knee
* Outerbridge classification \> 2 assessed during arthroscopy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hartford Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Bone and Joint Institute at Hartford Hospital

Hartford, Connecticut, United States

Site Status RECRUITING

Orthopedic Associates of Hartford

Hartford, Connecticut, United States

Site Status RECRUITING

PRISM Sports Medicine

Hartford, Connecticut, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Regina O Kostyun, MSEd

Role: CONTACT

860-972-2657

Facility Contacts

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Regina R Kostyun, MSEd

Role: primary

860-972-2657

Clifford Rios, MD

Role: primary

860-549-8295

Carl Nissen, MD

Role: primary

860-972-6688

References

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Ahn JH, Kim JG, Wang JH, Jung CH, Lim HC. Long-term results of anterior cruciate ligament reconstruction using bone-patellar tendon-bone: an analysis of the factors affecting the development of osteoarthritis. Arthroscopy. 2012 Aug;28(8):1114-23. doi: 10.1016/j.arthro.2011.12.019. Epub 2012 Mar 13.

Reference Type RESULT
PMID: 22421565 (View on PubMed)

Brown K, Solomon MJ, Young J, Seco M, Bannon PG. Addressing the ethical grey zone in surgery: a framework for identification and safe introduction of novel surgical techniques and procedures. ANZ J Surg. 2019 Jun;89(6):634-638. doi: 10.1111/ans.15104. Epub 2019 Apr 11.

Reference Type RESULT
PMID: 30974516 (View on PubMed)

Brydone AS, Meek D, Maclaine S. Bone grafting, orthopaedic biomaterials, and the clinical need for bone engineering. Proc Inst Mech Eng H. 2010 Dec;224(12):1329-43. doi: 10.1243/09544119JEIM770.

Reference Type RESULT
PMID: 21287823 (View on PubMed)

Cervellin M, de Girolamo L, Bait C, Denti M, Volpi P. Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study. Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):114-20. doi: 10.1007/s00167-011-1570-5. Epub 2011 Jun 16.

Reference Type RESULT
PMID: 21678095 (View on PubMed)

Kartus J, Stener S, Lindahl S, Engstrom B, Eriksson BI, Karlsson J. Factors affecting donor-site morbidity after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autografts. Knee Surg Sports Traumatol Arthrosc. 1997;5(4):222-8. doi: 10.1007/s001670050054.

Reference Type RESULT
PMID: 9430571 (View on PubMed)

Leathers MP, Merz A, Wong J, Scott T, Wang JC, Hame SL. Trends and Demographics in Anterior Cruciate Ligament Reconstruction in the United States. J Knee Surg. 2015 Oct;28(5):390-4. doi: 10.1055/s-0035-1544193. Epub 2015 Jan 30.

Reference Type RESULT
PMID: 25635874 (View on PubMed)

Mastrokalos DS, Springer J, Siebold R, Paessler HH. Donor site morbidity and return to the preinjury activity level after anterior cruciate ligament reconstruction using ipsilateral and contralateral patellar tendon autograft: a retrospective, nonrandomized study. Am J Sports Med. 2005 Jan;33(1):85-93. doi: 10.1177/0363546504265926.

Reference Type RESULT
PMID: 15611003 (View on PubMed)

Schandl K, Horvathy DB, Doros A, Majzik E, Schwarz CM, Csonge L, Abkarovits G, Bucsi L, Lacza Z. Bone-Albumin filling decreases donor site morbidity and enhances bone formation after anterior cruciate ligament reconstruction with bone-patellar tendon-bone autografts. Int Orthop. 2016 Oct;40(10):2097-2104. doi: 10.1007/s00264-016-3246-8. Epub 2016 Jun 29.

Reference Type RESULT
PMID: 27357530 (View on PubMed)

Walters BL, Porter DA, Hobart SJ, Bedford BB, Hogan DE, McHugh MM, Klein DA, Harousseau K, Nicholas SJ. Effect of Intraoperative Platelet-Rich Plasma Treatment on Postoperative Donor Site Knee Pain in Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: A Double-Blind Randomized Controlled Trial. Am J Sports Med. 2018 Jul;46(8):1827-1835. doi: 10.1177/0363546518769295. Epub 2018 May 9.

Reference Type RESULT
PMID: 29741923 (View on PubMed)

Xie X, Liu X, Chen Z, Yu Y, Peng S, Li Q. A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction. Knee. 2015 Mar;22(2):100-10. doi: 10.1016/j.knee.2014.11.014. Epub 2014 Dec 11.

Reference Type RESULT
PMID: 25547048 (View on PubMed)

Other Identifiers

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HHC-2021-0113

Identifier Type: -

Identifier Source: org_study_id

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