Anterior Knee Pain Reduction following Patellar-bone Defect Refiling in Bone–patellar Tendon–bone Autograft Anterior Cruciate Ligament Reconstruction: Comperative Analysis

Purpose:
Bone–patellar tendon–bone (BPTB) autograft remains the most widely used graft source for anterior cruciate ligament reconstruction (ACLR).The drawback associated with BPTB is increased donor-site morbidity such as anterior knee pain. The purpose of this study was to evaluate and compare anterior knee pain after refilling the patella bony defect with bone substitute.

Methods:
This is a retrospective analysis of a consecutive cohort of patients who underwent BTBP ACLR in the orthopedic department between January 1st 2015 to December 31st 2020. The cohort was divided into two groups; one in which refilling of patellar bony defect with bone substitute was done while the other did not. Demographics, reported anterior knee pain, VAS score, complications, re-surgery and patient subjective reported outcomes such as IKDC, TEGNER, LYSHOLM and SF-12 scores were compared between groups.

Results:
A total of 286 patients (284 males, 2 females) who underwent BTBP ACLR were included in this study. The "NO bone refilling" group consisted of 88 patients compared to 196 patients in the "bone refilling” group. The “bone refilling” group had statistically different reduced reported anterior knee pain at last clinic follow up (33.3% vs. 51.1% p=0.004) and patient reported questionnaire (41.9% vs 65.6, p-0.003). The "bone refilling” group has statistically significant reduced complications rates (21.7% vs 34.1, p=0.027) and clinical follow up reported VAS (2.18 vs. 3.13 p=0.004). No differences were found in Lyshol, Tegner, IKDC and SF-12 scores.

Conclusion:
Bone refilling in BTBP ACLR has shown significant reduction in anterior knee pain, post-operative complications and VAS scores.

Keywords: Bone–patellar tendon–bone, anterior cruciate ligament reconstruction, anterior knee pain, VAS, Tegner, IKDC, Lysholm, SF-12T