Anterior knee pain in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft and autologous bone grafting

doi:10.5312/wjo.v17.i1.112677

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Orthop. Jan 18, 2026; 17(1): 112677
Published online Jan 18, 2026. doi: 10.5312/wjo.v17.i1.112677

Anterior knee pain in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft and autologous bone grafting

Adhitya Byravamoni Venugopal, Nitin Chauhan, Sunit Wani, Leela Venkata Sai Krishna Maramreddy, Kushagra Pathak, Ravi Mittal

Adhitya Byravamoni Venugopal, Nitin Chauhan, Sunit Wani, Kushagra Pathak, Ravi Mittal, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India

Leela Venkata Sai Krishna Maramreddy, Department of Orthopaedics, Great Eastern Medical School, Srikakulam 532484, Andhra Pradesh, India

Co-first authors: Adhitya Byravamoni Venugopal and Nitin Chauhan.

Author contributions: Byravamoni Venugopal A and Chauhan N contributed equally in this work as co-first authors; Byravamoni Venugopal A, Chauhan N, Wani S, Maramreddy LVSK, and Pathak K were responsible for material preparation, data collection, and analysis; Byravamoni Venugopal A, Chauhan N, and Maramreddy LVSK revised the manuscript as per the journal reviewers; Byravamoni Venugopal A, Chauhan N, Maramreddy LVSK, and Mittal R designed the research study; Mittal R performed all surgeries; all authors participated in writing the original draft, and reviewed and edited the final manuscript, have read and agreed to the published version of the manuscript.

Institutional review board statement: This retrospective observational study was conducted after obtaining ethical approval from the Institutional Ethics Committee (All India Institute of Medical Sciences, New Delhi), No. AIIMSA4508/15.07.2025.

Informed consent statement: Written informed consent was obtained from the study participants for sharing their findings and pictures if any deidentifying their personal details.

Conflict-of-interest statement: The author has no relevant financial or non-financial interests to disclose.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Leela Venkata Sai Krishna Maramreddy, Assistant Professor, FRCS, FRCS (Ed), Department of Orthopaedics, Great Eastern Medical School, Ragolu, Srikakulam District, Andhra Pradesh, Srikakulam 532484, Andhra Pradesh, India. krishna.mlv.sai@gmail.com

Received: August 4, 2025
Revised: August 30, 2025
Accepted: November 11, 2025
Published online: January 18, 2026
Processing time: 159 Days and 21.2 Hours

Abstract

BACKGROUND

Anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autografts remains the gold standard for young, active individuals due to its superior biomechanical strength and bone-to-bone healing. However, donor site morbidity, particularly anterior knee pain (AKP), limits its utilization despite its advantages. Various techniques have been proposed to reduce AKP, but they show variable outcomes and several limitations.

AIM

To assess the incidence and severity of AKP following BPTB ACL reconstruction using an autologous bone grafting technique.

METHODS

We conducted a retrospective observational study of 24 patients aged 20-45 years, who had primary ACL reconstruction with BPTB grafts. During surgery, autologous cancellous bone generated from tunnel drilling was used to fill the patellar and tibial donor site voids after graft fixation. All patients were followed up for at least twelve months. Using the Kujala Anterior Knee Pain Score, clinical outcomes were evaluated, including the pain-specific subcomponent.

RESULTS

With scores ranging from 86 to 100, the average overall Kujala score was 95.67 ± 4.01. No patient scored below 85. There was no complication such as patellar fracture, tibial tuberosity fracture, or infection. Grouped data showed 20.8% of patients scored 100, whereas 54.2% scored between 95 and 99, and 25% scored between 86 and 94. One patient (4.2%) had an 8/10 pain subcomponent, whereas 23 patients (95.8%) had a 10/10.

CONCLUSION

This procedure is easy to incorporate into routine surgical practice, cost-effective and reproducible without requiring extra incisions or raising the patient’s surgical expenses. Excellent short-term results back up this technique.

Keywords: Knee; Anterior knee pain; Anterior cruciate ligament; Bone patellar tendon bone; Autograft

Core Tip: This study highlights that by utilizing bone already available from femoral and tibial tunnel drilling during bone-patellar tendon-bone anterior cruciate ligament reconstruction, routine bone grafting of donor tibial and patella harvest site defects is a simple and reproducible technique that results in excellent functional outcomes with minimal donor site morbidity. This method offers a cost-effective approach. The high Kujala scores and absence of clinically significant anterior knee pain in this cohort support the integration of this technique into standard surgical practice.