During Anterior Cruciate Ligament reconstruction, using bone- patellar tendon- bone graft, debris can accumulate in the joint. We assessed incidence and potential for complications, described the radiographic appearance and defined the natural history of these intrarticular debris in 50 consecutive reconstructions. The records and radiographs of 50 consecutive cases were reviewed. A stripe of radio-opaque material, resembling a comma, termed the “comma” sign, was noted behind the lateral femoral condyle on the early postoperative radiographs of 40 of the 50 cases. There was no statistically significant difference in loss of knee motion at six, twelve, twenty- six and fifty- two weeks postoperatively (P> 0.50) between the patients presenting the radio-opacity and those without it. A second set of radiographs was taken in 12 patients between 3 and 18 months postoperatively, revealing that this radio- opaque material was visible in 1 case only. No correlation was found between presence of radio- opacities and duration of pain, effusion, analgesia requirement, discharge timing, time to driving and time to work. A protocol of postoperative early weight- bearing mobilisation had been followed in all cases which may have played a role in promoting the faster dissolution of the debris.

The technique of arthroscopic decompression of patellar tendonitis was first undertaken in 1990. We report the 10 year experience of using this technique. Patients presenting with this condition were subjected to clinical, radiological and MRI assessment. The procedure was undertaken if the symptoms continued to be significant despite non-operative treatment. The procedure used a Dyonics shaver. The fat pad was elevated from the bare area of the patella to expose the non-articular inferior pole of the patella. The tendon fibres were then elevated from the anterior surface of the inferior pole, and the 5mm tip of the patella was excised taking particular care to ensure that the full AP thickness was removed.

Seventy three knees underwent surgery with a minimum of one year follow up, in four cases a simultaneous bilateral procedure was performed and in 11 cases previous surgery had been performed elsewhere. The average age was 33 years, 64 of the cases were male. The average duration of symptoms was 20 months and all patients had undergone non-operative treatment prior to the index procedure for an average duration of 10 months. The average duration of follow up was 49 months. All patients experienced a significant improvement in the clinical grade of symptoms and function with 95% of the 62 primary cases resulting in a good or excellent result. The average time to return to work and driving was 2 weeks and to sport was 9 weeks. In the 11 revision cases, 9 (81%) were improved and 6 (55%) had a good result.

The results of arthroscopic decompression for patellar tendonitis are superior to the other reported techniques. We conclude that excision of the inflammatory nodule and fat pad in this condition is unnecessary, other than to obtain visualisation of the inferior pole of the patella. The success of this procedure supports the suggestion that this condition is produced by a compression of the tendon and is best treated by decompression of the inferior patella pole.