Houston Methodist. Leading Medicine

Knee News

Doctors Warn: Don't Overload Donor Knee After ACL Repair

Sometimes it happens that a surgical repair fails and has to be done over. The authors of this study report two cases of early problems after a second (revision) ACL repair.

In the first case a 40-year old woman had injured her left ACL in two separate skiing accidents. She fell at home for a third knee injury. The middle third of the right patellar tendon was used as a graft to repair the ACL.

The night after surgery she had an avulsion fracture of the tibia. This means the remaining patellar tendon pulled away from the bone where it normally inserts. Another operation was needed to repair the fracture.

In the second case a 39-year-old woman had a right ACL repair two years ago. She went to the orthopedic surgeon with reports of right knee pain. She had surgery to repair a torn meniscus and revise the previous ACL repair. A piece of her patellar tendon taken from the other leg was used to repair the ACL.

The same day while pivoting to move from a stretcher to a wheelchair, she felt a pop in her knee. An MRI showed the patellar tendon had pulled away from the tibia (lower leg bone). Surgery was done to repair the new damage.

These case studies show that problems can occur after ACL revision surgery using graft tissue from the other knee. The authors warn against overloading the donor knee. Overload can occur while the patient is still under the influence of a local anesthesia. Patients have a tendency to shift too much weight off the repaired knee onto the donor knee.


Benjamin T. Busfield, MD, et al. Extensor Mechanism Disruption After Contralateral Middle Third Patellar Tendon Harvest for Anterior Cruciate Ligament Revision Reconstruction. In Arthroscopy. October 2005. Vol. 21. No. 10. Pp. 1268.e1-1268.e6.

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