Osteophyte formation following bone-patella-bone ACL grafts

[SPWebster]

Has anybody encountered problems with osteophyte formation at the donor sight following bone-patella-bone grafts for ACL reconstruction. If so, how was the problem treated, and was it successful? Surgery was approx. 1 year ago

[marcelkorper]

If you want info try JBJS medscape ... or use their links

[perfphysio]

Osteophyte formation must be discussed at the indivivual level. Clearly their overactive repair systems or an overjealous rehab process has subjected them to this additional bone growth, which is actually a normal process albeit excessive. The excess may be due to "to much to soon" on the patella tendon, or may be a feature of the individuals physiology. Once that is assessed you should initially treat it as if it were a patella tendonitis, reduce the training load, look at their core stability to see if week glutes are allowing for an increased dynamic q angle. The look at the foot and ankle component.

Time usually allows the pain associated with otteophyte formation burn out (as in osgood schlatters disease) however this may take 12-18 months. Supplementation during the rehab process with things like glucosamine sulphate have proved clinically successful in my experience so I always look at diet as well.

It appears that some clients are prone to osteophyte formation just as others are prone to following a quads tear. Unless your feel that the graft position is inappropriate and rotational stability is still a huge problem surgery should be a low rated option. Surgery would be a last resort because if the factors above are not addressed then you will be facing the situation all over again!!!

reassure the client that this is not uncommon, the pain is not from the bone per sey, it is from the inflammatory and healing process associated with its formation.
Hope this helps.