A Novel Scoring Instrument to Assess Donor Site Morbidity After Anterior Cruciate Ligament Reconstruction With a Patellar Tendon Autograft at 2-Year Follow-up Using Contemporary Graft-Harvesting Techniques

Abstract

Background: Donor site morbidity after anterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone (BTB) autograft is clinically significant, but evidence with contemporary techniques is lacking. Purpose: To (1) evaluate donor site morbidity at a single institution using modern techniques of BTB autograft harvest at 2-year follow-up, (2) develop a 10-question donor site morbidity instrument, and (3) compare this instrument against traditional outcome tools. Study Design: Case series; Level of evidence, 4. Methods: We analyzed the 2-year follow-up outcomes of 200 consecutive patients who underwent ACL reconstruction with a BTB autograft performed by 2 surgeons at a single institution. The surgical technique utilized modern and consistent BTB autograft harvest, including graft sizing, patellar tendon and peritenon closure, and patellar and tibial donor site bone grafting. There were 187 patients included, with 13 patients undergoing revision ACL reconstruction excluded. An original 10-question scoring instrument evaluating donor site morbidity was administered to each patient (score, 0-100) and compared against each patient’s International Knee Documentation Committee (IKDC) and Lysholm scores. Results: Overall, 13.9% of patients were noted to have anterior knee pain with activity at 2-year follow-up. Moreover, 3.7% of patients reported an inability to kneel on hard surfaces but had no problems on soft surfaces; 5.9% of patients reported mild discomfort but were able to kneel on all surfaces. Additionally, 75.4% of patients had a perfect (100/100) donor site morbidity score. The mean donor site morbidity score at 2-year follow-up was 98.3 ± 3.4. There was a very strong correlation between the IKDC and Lysholm scores but only a strong and moderate correlation when the donor site morbidity score was compared with the IKDC and Lysholm scores, respectively. Conclusion: Donor site morbidity after ACL reconstruction with a BTB autograft was less frequent than reported in the existing literature. Some patients developed anterior knee pain; therefore, an informed discussion is advised. IKDC and Lysholm scores may not capture donor site symptoms after surgery. The 10-question donor site morbidity instrument may provide a more accurate assessment.

Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

“…The primary outcomes were graft failure and donor site morbidity. Based on the definition of donor site morbidity in the included studies (Appendix Table A1, available in the online version of this article) and previous studies evaluating donor site morbidity after ACL reconstruction, 35,47,71 in this meta-analysis, donor site morbidity was defined as tenderness, numbness, or irritation at the donor site; anterior knee pain; and difficulty in kneeling or knee-walking. Graft failure was defined as the presence of greater than 5 mm of anterior laxity.…”

Anterior Cruciate Ligament Reconstruction in 107 Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 6-Year Follow-up

“… 16 In addition, donor-site morbidity at 2 years of follow-up was minimal, with up to 75.4% of patients reporting a perfect donor-site morbidity score. 16 …”

“…Although anterior knee pain and donor-site pain have been well studied to date, a recent investigation of 200 consecutive BTB autografts demonstrated that around 13.9% of patients can expect some anterior knee pain with activity but only 3.7% reported an inability to kneel on hard surfaces. 16 In addition, donor-site morbidity at 2 years of follow-up was minimal, with up to 75.4% of patients reporting a perfect donor-site morbidity score. 16 A more recent area of discussion within ACL graft selection is with respect to graft diameter.…”

“…16 In addition, donor-site morbidity at 2 years of follow-up was minimal, with up to 75.4% of patients reporting a perfect donor-site morbidity score. 16 A more recent area of discussion within ACL graft selection is with respect to graft diameter. In 2019, Snaebjo ¨rnsson et al 40 published a retrospective review of the national knee ligament registries of Norway and Sweden, where they identified 18,425 patients who underwent an ACLR with 1329 PT and 17,096 HT autografts.…”

Electrospun Nanofibrous Composite Membranes for Long‐Term Release of Celecoxib for Achilles Tendon Reconstruction Following Injury

“…[49][50][51][52] Despite the various advantages documented, there are some drawbacks such as autografts have limited efficacy owing to donor site morbidity. [53][54][55] Meanwhile, allografts, xenografts, and synthetic tendons are notorious for graft-host integration and limited longterm utility. [55][56][57] Meanwhile, previous studies demonstrated that the collagen incorporated in PLGA nanofibers exhibited an exceptional capacity for cell adhesion migration.…”