Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts

The authors review the current knowledge on donor site-related problems aft er using different types of autografts for anterior cruciate ligament (ACL) reconstruction and make recommendations on minimizing late donor-site prob lems. Postoperative donor-site morbidity and anterior knee pain following A CL surgery may result in substantial impairment for patients. The selection of graft, surgical technique, and rehabilitation program can affect the se verity of pain that patients experience. The loss or disturbance of anterio r sensitivity caused by intraoperative injury to the infrapatellar nerve(s) in conjunction with patellar tendon harvest is correlated with donor-site discomfort and an inability to kneel and knee-walk. The patellar tendon at the donor site has significant clinical, radiographic, and histologic abnor malities 2 years after harvest of its central third. Donor-site discomfort correlates poorly with radiographic and histologic findings after the use o f patellar tendon autografts. The use of hamstring tendon autografts appear s to cause less postoperative donor-site morbidity and anterior knee proble ms than the use of patellar tendon autografts. There also appears to be a r egrowth of the hamstring tendons within 2 years of the harvesting procedure . There is little known about the effect on the donor site of harvesting fa scia lata and quadriceps tendon autografts, Efforts should be made to spare the infrapatellar nerve(s) during ACL reconstruction using patellar tendon autografts. Reharvesting the patellar tendon cannot be recommended due to significant clinical, radiographic, and histologic abnormalities 2 years af ter harvesting its central third. It is important to regain full range of m otion and strength after the use of any type of autograft to avoid future a nterior knee problems. If randomized controlled trials show that the long-t erm laxity measurements following ACL reconstruction using hamstring tendon autografts are equal to those of patellar tendon autografts, we recommend the use of hamstring tendon autografts because there are fewer donor-site p roblems.