Common problem after ACL reconstruction and its frequency is related to the type of graft used. While patellar tendon grafts and hamstring autografts produce the most stable knees, as opposed to cadaver or allo grafts which fail much more frequently, many studies have shown that patellar tendon grafts have a much higher incidence of problems related to the patellar tendon, such as patellar tendinitis, and patella or kneecap where the graft is taken from. The choice between grafts is largely based on the surgeon’s comfort with one graft or the other and their interpretation of the medical literature. Twenty years ago most patients were treated with patellar tendon grafts. But now hamstring grafts overall are the most commonly used graft in the United States and worldwide with patellar tendon grafts a close second.
I use hamstring grafts exclusively (and published a paper showing restoration of stability in all patients.) I use the hamstring graft specifically because of the lower incidence of kneecap or patellar tendon related problems. I particularly worry about this in a jumping athlete because of the incredible tensile load applied to the patellar tendon. Using the hamstring graft allows the patellar tendon to be avoided and decreases problems related to it. This is true even for the best surgeons: and Zach Levine’s operating surgeon is one of the very best, as is his current team doctor with the Chicago Bulls. I do not know if he had a patellar tendon graft, and some hamstring patients experience similar pain, but the incidence is about half with hamstring compared to the patellar tendon.
Post ACL reconstruction patellar tendinitis tends to decrease in the second year after surgery and hopefully it will for this outstanding athlete. Relative rest – ie avoiding aggravating activities while performing other exercises to maintain conditioning – is the mainstay of treatment, although progress may be frustratingly slow. We avoid NSAID drugs (motrin, advil, aleve, meloxicam, diclofenac, Celebrex, are the most common) due to their role in slowing healing, masking pain and their side effects – stomach ulcers, kidney problems and reduction in sperm count to name a few. Our philosophy in this area can be seen in our No Pills No Pain paradigm. However many doctors do use these drugs and feel that they are effective.
In our hands platelet rich plasma has been very effective in treating patellar tendinitis and is our preferred treatment, but it tends to produce soreness for several days so it may not be an ideal alternative for an athlete in season.
