Patella Fractures With Bone–Patella Tendon–Bone Autografts for Anterior Cruciate Ligament Reconstruction

The bone–tendon–bone autograft currently is the most widely used graft for anterior cruciate ligament (ACL) reconstructions, although numerous other allograft and autograft choices are available. Patella fractures after ACL reconstructions using bone-tendon-bone autografts are a recognized, but rarely reported, complication. The incidence of such fractures has been reported to be between 0.23% and 2.3%. Patella fractures can occur either intraoperatively, from an overly aggressive bony resection, or postoperatively, from direct trauma. Intraoperative fractures typically are longitudinal fissures whereas postoperative patella fractures commonly are stellate or transverse. Nondisplaced fractures can be treated nonoperatively with rigid knee immobilization whereas displaced fractures should be treated with open reduction and internal fixation. When rapid rehabilitation is paramount, some authors have advocated that all fracture patterns received rigid fixation for earlier movement and more rapid restoration of the extensor mechanism. Regardless of treatment protocol, numerous authors have shown minimal long term sequela and comparable final outcomes whether a fracture is present or not. We review the anatomy of the extensor mechanism, the surgical technique of properly harvesting the bone-patella tendon-bone autograft, and various treatment protocols for the management of patella fractures.