Anterior Knee Pain After ACL Reconstruction: How to Avoid It

2012 ◽  
pp. 357-372
Author(s):  
Vicente Sanchis-Alfonso ◽  
Erik Montesinos-Berry ◽  
Alfredo Subías-López ◽  
Joan Carles Monllau
Keyword(s):  
Acl Reconstruction ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Anterior Knee

Complications After Anterior Cruciate Ligament Reconstruction and Their Relation to the Type of Graft: A Prospective Study of 958 Cases

2019 ◽  
Vol 47 (11) ◽  
pp. 2543-2549 ◽  
Author(s):  
Romain Rousseau ◽  
Charlotte Labruyere ◽  
Charles Kajetanek ◽  
Olivia Deschamps ◽  
Konstantinos G. Makridis ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Cruciate Ligament ◽  
Meniscal Lesions ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Complications and adverse events after anterior cruciate ligament (ACL) reconstruction are well known, but they have been underestimated in previous studies. Purpose: To describe the complications and adverse events after ACL reconstruction within a 2-year follow-up and analyze them in relation to the type of graft. Study Design: Cohort study; Level of evidence, 3. Methods: From 2000 to 2012, 958 patients with an isolated ACL injury underwent surgery by a single knee surgeon. ACL reconstruction was performed with the medial portal technique for the femoral tunnel and the use of bone–patellar tendon–bone (BPTB) or hamstring tendon graft. Patients were reviewed at 6 weeks and 3, 6, 12, and 24 months after surgery with the International Knee Documentation Committee score, plain radiographs, and the KT-1000 arthrometer. Results: Of 958 patients enrolled, 147 (15%) were lost at last follow-up. The 2 groups (bone–patellar tendon–bone [n = 257] and hamstring [n = 554]) were similar regarding the mean age at the time of surgery and preoperative anterior laxity. The main complications were as follows: anterior knee pain (n = 130 of 811, 16%), stiffness (n = 72, 8.8%), secondary meniscal lesions (n = 59, 7.2%), pain attributed to fixation (n = 79, 9.7%), ACL rerupture (n = 47, 5.7%), contralateral ACL ruptures (n = 24, 3%), patellar fractures (n = 3, 0.3%), infections (n = 9, 1%), and thromboembolic complications (n = 5, 0.6%). There was no significant difference between the grafts with respect to the frequency of joint stiffness, secondary meniscal lesions, or anterior knee pain. During the first 2 postoperative years, the percentage of patients with anterior knee pain was higher in the patellar tendon group (23.3% vs 12.6%, P < .001); however, this difference was not significant after the 2-year interval (3.1% vs 2.5%, P = .63). The percentage of patients with a rerupture of the graft was significantly lower in the patellar tendon group than in the hamstring group (25 of 811 [3.1%] vs 57 of 811 [7%], P = .023). Similar results were recorded regarding the pain related to the hardware material (7 of 811 [0.8%] in the BPTB group vs 113 of 811 [13.9%] in the hamstring group, P = .001). The percentage of ACL ruptures contralateral to the repair was higher in the patellar tendon group (41 of 811 [5%] vs 17 of 811 [2%], P = .016). Conclusion: The total rate of complications after an ACL reconstruction was 39%, and the surgical revision rate for any reason was 28%. Problems with the hardware material were more frequent in the hamstring group, leading to an increased rate of surgical revision. Anterior knee pain was initially higher in the patellar tendon group, but there was no significant difference in a 2-year interval. The rerupture rate was statistically higher in the hamstring group.

Lysis of Pretibial Patellar Tendon Adhesions (Anterior Interval Release) to Treat Anterior Knee Pain after ACL Reconstruction

2006 ◽  
pp. 295-303
Author(s):  
Sumant G. Krishnan ◽  
J. Richard Steadman ◽  
Peter J. Millett ◽  
Kimberly Hydeman ◽  
Matthew Close
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Anterior Knee

scholarly journals Anterior knee pain in ACL reconstruction with BPTB graft – Is it a myth? Comparative outcome analysis with hamstring graft in 1,250 patients

2020 ◽  
Vol 22 ◽  
pp. 408-413
Author(s):  
Gopalakrishnan Janani ◽  
Perumal Suresh ◽  
Ayyadurai Prakash ◽  
Jeganathan Parthiban ◽  
Karthik Anand ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Outcome Analysis ◽  
Hamstring Graft ◽  
Bptb Graft ◽  
Anterior Knee

scholarly journals Effect of anterior cruciate ligament reconstruction with hamstring tendons on Insall-Salvati index and anterior knee pain

2018 ◽  
Vol 146 (3-4) ◽  
pp. 174-178
Author(s):  
Ozgur Korkmaz ◽  
Melih Malkoc
Keyword(s):  
Acl Reconstruction ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Lysholm Score ◽  
Activity Score ◽  
First Year ◽  
Anterior Cruciate ◽  
Anterior Knee

Introduction/Objective. The aim of this study was to evaluate the relationship between anterior knee pain and Insall-Salvati ratio after anterior cruciate ligament (ACL) reconstruction with hamstring tendon. Methods. We have evaluate 39 patient that had an ACL reconstruction surgery with hamstring tendon retrospectively. 14 patient had anterior knee pain at the and of the first year of the surgery. All the patient were evaluated for Insall-Salvati ratio preoperatively and postoperatively. Patients were evaluated at the end of the first year after the surgery with Lysholm score and Tegner activity scale. Patients preoperative and postoperative measurements were analyzed by using the Wilcoxon test and differences between patients with anterior knee pain and without pain was analyzed by the Mann-Whitney U test. Results. Mean Insall-Salvati ratio was found preoperatively 0,91?0,1 and postoperatively 0,85?0,09 (p?0,05). Mean Tegner activity score was 8,56?1,04 and mean Lysholm score was 87,36?9,42 in the group without anterior knee pain. Mean Tegner activity score was 7,21?0,97 and mean Lysholm score was 74,43?9,94 in the group with anterior pain. There is an decrease in ?nsall-Salvati ratio as a result of the surgery. But patients with anterior knee pain had lower values of ?nsall-Salvati ratio preoperatively. Conclusion. Preoperatively low ?nsall-Salvati ratio can be premised indicator of anterior knee pain in the early period after ACL reconstruction with hamstring tendons. Mean Tegner activity score and mean Lysholm score have higher values in the group without anterior pain post operatively.

scholarly journals Prospective and Randomized Clinical Evaluation of Hamstring Versus Patellar Tendon Autograft for Anterior Cruciate Ligament Reconstruction in Soccer Players

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110281
Author(s):  
Luiz Gabriel Betoni Guglielmetti ◽  
Victor Eduardo Roman Salas ◽  
Pedro Baches Jorge ◽  
Fabrício Roberto Severino ◽  
Aires Duarte ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Cruciate Ligament ◽  
Soccer Players ◽  
Outcome Score ◽  
Anterior Cruciate ◽  
Anterior Knee

Background: Anterior cruciate ligament (ACL) reconstruction is usually performed with autologous bone–patellar tendon–bone (PT) or hamstring tendon (HT) graft. There has been only 1 randomized clinical trial examining ACL reconstruction with these grafts specifically in soccer players, and more studies comparing these graft types within a homogenous cohort such as soccer athletes may better highlight differences in outcomes. Purpose: To compare the results of ACL reconstruction with PT versus HT autograft in soccer players and to evaluate objective and subjective outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 62 professional or semiprofessional soccer players (mean age, 25.1 years) with ACL injury were randomized to undergo reconstruction with PT or HT autograft by a single orthopaedic surgeon (n = 31 in each group). Outcome measures were recorded preoperatively and at 2 years postoperatively. The primary outcome was the modified Cincinnati Knee Rating System, and secondary outcomes were the objective and subjective International Knee Documentation Committee scores, Lachman test, pivot-shift test, anterior drawer test, and Lysholm score. The following variables were also evaluated postoperatively: return to soccer, level at return, graft rerupture, postoperative complications, anterior knee pain, patellar tendinitis, difficulty sprinting, and loss of kicking power. Results: The PT and HT groups were homogenous in terms of age, sex distribution, injured side, and time from injury to surgery, and there was no difference between them on any preoperative outcome score. At 2 years postoperatively, there were no differences between the groups on any outcome score; however, there were significantly fewer patients with anterior knee pain in the HT group compared with the PT group (7 [22.6%] vs 15 [48.4%], respectively; P = .03). Two patients from each group (2/31; 6.5%) sustained rerupture. Conclusion: There were no differences between soccer players who underwent different types of ACL reconstruction with the exception of anterior knee pain, which was more frequent in players who underwent reconstruction with PT graft. Registration: NCT02642692 ( ClinicalTrials.gov ).

scholarly journals Ceramic Bone Graft Substitutes do not reduce donor-site morbidity in ACL reconstruction surgeries: a pilot study

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 14
Author(s):  
Naresh Dhanakodi ◽  
Jai Thilak ◽  
Jacob Varghese ◽  
Krishnankutty Venugopal Menon ◽  
Harikrishna Varma ◽  
...  
Keyword(s):  
Bone Graft ◽  
Acl Reconstruction ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Control Group ◽  
Study Group ◽  
Bptb Graft ◽  
Anterior Knee

Introduction:Anterior knee pain is a major problem following Bone-patellar-tendon-bone graft (BPTB) use in anterior cruciate ligament (ACL) reconstruction. We hypothesized that filling the donor defect sites with bone-graft substitute would reduce the anterior knee symptoms in ACL reconstruction surgeries.Material and Methods: Patients operated for ACL-deficient knee between March 2012 and August 2013 using BPTB graft were divided into two treatment groups. The patellar and tibial donor-site bony defects were filled-up with Hydroxyapatite–Bioglass (HAP:BG) blocks in the study group (n = 15) and no filler was used in the control group (n = 16). At 2 years, the clinical improvement was assessed using International Knee Documentation Committee (IKDC) score and donor-site morbidity was assessed by questionnaires and specific tests related to anterior knee pain symptoms.Results: Donor-site tenderness was present in 40% patients in the study group and 37.5% patients in the control group (p = 0.59). Pain upon kneeling was present in 33.3% patients in the study group and 37.5% patients in the control group (p = 0.55). Walking in kneeling position elicited pain in 40% patients in the study group and 43.8% in the control group (p = 0.56). The mean visual analogue score for knee pain was 3.0 in the study group and 3.13 in the control group, with no statistically significant difference (p = 0.68). Unlike control group, where a persistent bony depression defect was observed at donor sites, no such defects were observed in the study group.Conclusion:Filling the defects of donor sites with HAP:BG blocks do not reduce the anterior knee symptoms in patients with ACL reconstruction using autogenous BPTB graft.

scholarly journals Comparing Bone-Tendon Autograft With Bone-Tendon-Bone Autograft for ACL Reconstruction: A Matched-Cohort Analysis

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712097022
Author(s):  
Christian A. Cruz ◽  
Daniel Goldberg ◽  
Jeffrey Wake ◽  
Joshua Sy ◽  
Brian J. Mannino ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Pain ◽  
Anterior Knee Pain ◽  
Graft Failure ◽  
Patellar Fracture ◽  
Acl Graft ◽  
Functional Scores ◽  
Bone Plug ◽  
Tendon Autograft ◽  
Anterior Knee

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) using bone-tendon-bone (BTB) autograft is associated with increased postoperative anterior knee pain and pain with kneeling and has the risk of intra- and postoperative patellar fracture. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous fixation. Given the disadvantages of BTB, an alternative is a bone-tendon autograft (BTA) procedure that has been developed at our institution. BTA is a patellar tendon autograft with the single bone plug taken from the tibia. Purpose/Hypothesis: The purpose of this study was to evaluate the short-term outcomes of BTA ACLR. We hypothesized that this procedure will provide noninferior failure rates and clinical outcomes when compared with a BTB autograft, as well as a lower incidence of anterior knee pain, pain with kneeling, and patellar fracture. Methods: A consecutive series of 52 patients treated with BTA ACLR were retrospectively identified and compared with 50 age-matched patients who underwent BTB ACLR. The primary outcome was ACL graft failure, while secondary outcomes included subjective instability, anterior knee pain, kneeling pain, and functional outcome scores (Single Assessment Numeric Evaluation, Lysholm, and International Knee Documentation Committee subjective knee form). Results: At a mean follow-up of 29.3 months after surgery, there were 2 reruptures in the BTA cohort (4.0%) and 2 in the BTB cohort (4.0%). In the BTA group, 18% of patients reported anterior knee pain versus 36% of the BTB group ( P = .04). A total of 22% of patients noted pain or pressure with kneeling in the BTA cohort, as opposed to 48% in the BTB cohort ( P = .006). There were no differences in functional scores. In the BTA group, 94.2% of patients reported that their knees subjectively felt stable, as compared with 86% in the BTB group ( P = .18). Conclusion: This study demonstrated that the BTA ACLR leads to similarly low rates of ACL graft failure requiring revision surgery, with significantly decreased anterior knee pain and kneeling pain when compared with a BTB. Additionally, the potential complications of graft-tunnel mismatch and patellar fracture are eliminated with the BTA ACLR technique.

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