Summary

Bone-Patella Tendon Tendon-Bone ACL reconstruction with refilling of harvest sites leads to similar low rates of anterior knee pain when compared to hamstring ACL reconstruction

Abstract

Introduction

Bone-Patellar Tendon-Bone (BPTB)-anterior cruciate ligament (ACL)-reconstruction is known to be a reliable treatment option, which has been the gold standard for many years in ACL surgery. Due to reported high donor site morbidity, ACL reconstruction with hamstring or quad-tendon autograft has increased in popularity in recent years. However, it may be argued that the BPTB graft still leads to reduced laxity and rerupture rates, needed for successful return to pivoting sports especially in specific age groups. Therefore the BPTB graft is still widely used in athletes and young patients, despite the potential risk of anterior knee pain.

Purpose

To evaluate the donor site morbidity in a modified BPTB harvesting technique combining press-fit and suspensory fixation without the use of interference screws and autologous refilling of the donor site to reduce anterior knee pain, compared to hamstring ACL-reconstruction.

Methods

100 patients undergoing primary ACL reconstruction (ACLR) with either a modified BPTB ACLR technique or ACLR with hamstring autograft (HT), were prospectively evaluated. The modified BPTB technique uses suspensory fixation on both sides. Autologous bone from the use of an oscillating core reamer when creating the tibial tunnel is used to refill donor sites and the tibial tunnel. All patients with a minimum follow up of 2-years were included in this study.
Outcome assessed the occurrence of anterior knee pain and overall subjective outcomes, the ACL Donor Site Morbidity Questionnaire, Forgotten Joint score (FJS), IKDC score, and VAS score. Additionally, objective knee laxity was evaluated with the KT-1000 as side-to-side difference in anterior tibial translation (ATT-SSD)

Results

At final 2-year follow up in patients undergoing modified BPTB or HT ACLR, no significant differences in subjective outcomes for ACL Donor Site Morbidity Questionnaire (BPTB, 90.5 11.1 vs. HT, 94.6 11.1, p = .165), IKDC score (BPTB, 91.5 9.9 vs. HT, 90.1 10.7, p = .585), and VAS score were found (BPTB, 0.6 1.6 vs. HT, 0.3 0.8, p = .299). Additionally, KT-1000 (ATT-SSD) was not significantly different comparing both groups (BPTB, -0,5mm (±1,9) vs. HT 0.7mm (±2,1), p = .359)

Conclusion

Donor side morbidity in a modified BPTB ACLR technique with refilling of harvest sites was not shown to be significantly different as compared to ACLR with hamstring autograft. ACLR with BPTB autograft still has its value in primary and revision ACL surgery and should be considered with a modified and less morbid modern- day approach.