Techniques for reducing anterior knee symptoms after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft

Seventy-five patients underwent unilateral anterior cruciate ligament recon struction with an ipsilateral bone-patellar tendon-bone autograft at our in stitution. The graft was harvested using a two-transverse-incision techniqu e, and patellar and tibial bony defects were repaired with cored bone graft s collected by reaming the femoral socket and the tibial socket or tunnel. We evaluated the incidence of anterior knee pain, donor site tenderness, an d sensory disturbance after use of these procedures. We also analyzed the c orrelation between anterior knee pain and age, sex, bone plug length, range of motion, postoperative stability, patellar tendon shortening, infrapatel lar nerve injury, and the size of the patellar defect. Thirteen patients re ported anterior knee pain. Donor site tenderness was detected in 10 patient s and was located on the inferior pale of the patella, the tibial tubercle, or both. Sensory disturbance was found over the infrapatellar nerve area i n 13 patients, Statistical analysis showed that anterior instability (side- to-side difference of > 3 mm) and residual patellar bony defect (depth > 2 mm) were risk factors for anterior knee pain. The results of our study sugg est that cored cancellous bone grafting for complete restoration of the don or site bony defects and the two-transverse-incision technique to preserve the infrapatellar branch of the saphenous nerve contribute to prevention of anterior knee symptoms.