Anterior knee pain in the short term following ACL reconstruction comparing hamstring autograft and bone-patellar tendon-bone autograft with refilling of harvest sites. A retrospective matched-pair analysis

Abstract

Aims and Objectives:With current trends towards individualized anterior cruciate ligament (ACL) surgery, especially in younger patients performing high pivoting sports and patients with hyperlaxity, the bone-patellar tendon-bone (BPTB) autograft and its advantages in primary ACL reconstruction, have been brought into focus. Still concern remains about donor site morbidity, especially kneeling pain, due to bone block harvesting at the distal patella and tibial tuberosity. There is ongoing scientific effort to reduce this weakness of BPTB-harvesting techniques, without satisfying results so far. This study compares anterior knee pain (AKP) in patients receiving hamstring tendon (HS) and those patients treated with BPTB autograft ACL reconstruction, respectively. In the latter group harvest sites were refilled with autologous bone material from an oscillating hollow saw used to create the tibial tunnel. The aim of this study was, to compare both techniques that there is no significant difference in postoperative knee pain and kneeling pain in the early follow up period.Materials and Methods:Forty-two patients with primary ACL reconstruction (21 BPTB, group A; 21 HS, group B) were retrospectively analyzed obtaining matched pairs based on age (±5 years), length of follow up (18 ± 6 months) and gender.Preoperative radiological analysis of patellofemoral cartilage defects were recorded using MRI scans and arthroscopic images (modified Outerbridge grading). Additionally clinical and patient-reported outcome measures were obtained, assessing range-of-motion, knee-laxity (Lachman, anterior-drawer test), activities of daily living and sports activity scale (KOS-ADL and SAS score) and graft or contralateral ACL tear occurring during follow up.Results:At short term follow up clinical parameters were similar between patients treated either with hamstring or BPTB autograft. Scores showed higher values for daily living (KOS-ADLS) in the short term in group A (P<0,05), in contrary group B showed higher scores for the KOS-SAS (P<0,05). More patients avoid kneeling on the operated knee after BPTB-autograft reconstruction, without impairing activities of daily living or sports participation. No significant difference existed between clinical stability measures or range of motion at follow up.Conclusion:Our study showed that ACL reconstruction with HS or BPTB autograft has successful short term outcome, with high probability of returning to unimpaired activities of daily living. This study shows that refilling of harvest sites with autologous bone material taken from an hollow saw used for creation of the tibial tunnel leads to acceptable donor site morbidity, without restriction in daily activities and sports participation, respectively. It can therefore be assumed that BPTB autograft without leaving bony defects at the harvest sites is a safe procedure with low donor site morbidity, being relevant in individualized ACL reconstruction.