Following Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Autograft, the Incidence of Anterior Knee Pain Ranges From 5.4% to 48.4% and the Incidence of Kneeling Pain Ranges From 4.0% to 75.6%: A Systematic Review of Level I Studies

Abstract

PurposeTo 1.) perform a systematic review of level I randomized controlled trials detailing the incidence of anterior knee pain and kneeling pain following anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft and 2.) investigate the effect of bone grafting the patella harvest site on anterior knee and kneeling pain. MethodsA systematic review of the level I studies from 1980 to 2023 was performed according to PRISMA guidelines. The primary outcome evaluated was the presence of donor site morbidity in the form of anterior knee pain or kneeling pain. A secondary sub-analysis was performed to assess for differences in the incidence of postoperative pain between patient groups undergoing ACLR with BPTB receiving harvest-site bone grafting versus those in which the defect was left untreated. ResultsFollowing full-text review, 15 studies reporting on a total of 696 patients met final inclusion criteria. Patients were followed for an average of 4.8 years (range, 2.0 to 15.3 years) and the mean age ranged from 21.7 to 38 years old. The incidence of anterior knee pain, calculated from 354 patients across 10 studies, ranged from 18.0% to 48.0%. The incidence of postoperative pain with kneeling was determined to range from 10.0% to 62.0% in 490 patients from 9 studies. Patients treated with bone grafting of the BPTB harvest site had no significant difference in incidence of any knee pain compared to those that were not grafted, with incidences of 43.3% and 40.2%, respectively. ConclusionBased on the current level 1 randomized controlled trial data, the incidence of anterior knee pain and kneeling pain following ACLR with BPTB autograft ranges from 18.0% to 48.0% and 10.0% to 62.0%, respectively.