Pathak K, Chauhan N, Maramreddy LVSK, Mittal R. Letter to the Editor: Surgical refinements and autologous bone grafting to reduce donor-site morbidity in bone-patellar tendon-bone anterior cruciate ligament-reconstruction. World J Orthop 2026; 17(10): 126137 [DOI: 10.5312/wjo.126137]
Corresponding Author of This Article
Leela Venkata Sai Krishna Maramreddy, FRCS, FRCS (Ed), Consultant, Postdoctoral Fellow, Department of Orthopaedics, Kasa Multispeciality Hospitals, Pogathota, Nellore 524001, Andhra Pradesh, India. krishna.mlv.sai@gmail.com
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Orthopedics
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letter
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Pathak K, Chauhan N, Maramreddy LVSK, Mittal R. Letter to the Editor: Surgical refinements and autologous bone grafting to reduce donor-site morbidity in bone-patellar tendon-bone anterior cruciate ligament-reconstruction. World J Orthop 2026; 17(10): 126137 [DOI: 10.5312/wjo.126137]
World J Orthop. Oct 18, 2026; 17(10): 126137 Published online Oct 18, 2026. doi: 10.5312/wjo.126137
Letter to the Editor: Surgical refinements and autologous bone grafting to reduce donor-site morbidity in bone-patellar tendon-bone anterior cruciate ligament-reconstruction
Kushagra Pathak, Nitin Chauhan, Leela Venkata Sai Krishna Maramreddy, Ravi Mittal
Kushagra Pathak, Nitin Chauhan, Ravi Mittal, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Leela Venkata Sai Krishna Maramreddy, Department of Orthopaedics, Kasa Multispeciality Hospitals, Nellore 524001, Andhra Pradesh, India
Author contributions: Pathak K, Chauhan N, and Maramreddy LVSK were involved in writing the correspondence and it was reviewed and the revisions were done by Mittal R.
AI contribution statement: No use of AI tools.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Leela Venkata Sai Krishna Maramreddy, FRCS, FRCS (Ed), Consultant, Postdoctoral Fellow, Department of Orthopaedics, Kasa Multispeciality Hospitals, Pogathota, Nellore 524001, Andhra Pradesh, India. krishna.mlv.sai@gmail.com
Received: July 27, 2026 Revised: September 11, 2026 Accepted: October 14, 2026 Published online: October 18, 2026 Processing time: 82 Days and 23 Hours
Abstract
Anterior knee pain is a well-recongized, multifactorial issue after anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. We appreciate the comprehensive commentary by Olaran and Garcia-Mansilla on our recently published study “Anterior knee pain in anterior cruciate ligament -reconstruction using bone-patellar tendon -bone graft and autologous bone grafting”. In this reply, we acknowledge the limitations of our retrospective, single-center study and emphasize the need for larger prospective randomized trials. We also clarify key technical aspects of our approach, including meticulous graft harvest, autologous bone grafting of patellar and tibial donor-site defects using cancellous bone obtained during tunnel drilling and avoidance of soft-tissue and cartilage injury. These refinements have helped in reduction of donor-site morbidity and anterior knee pain after bone-patellar tendon-bone anterior cruciate ligament-reconstruction in our patient cohort. However, these descriptive findings in a retrospective study are hypothesis-generating and cannot establish definitive preventive efficacy. Prospective randomized trials are required to evaluate the independent impact of these surgical refinements on donor-site morbidity.
Core Tip: While bone-patellar tendon-bone autografts provide excellent stability in anterior cruciate ligament reconstruction, donor-site morbidity and anterior knee pain remain prevalent. In this reply we outlined a dual protective strategy to overcome these challenges, we performed meticulous handling of the soft tissues using oblique incisions and mallet-free osteotomes to protect both the nerves and cartilage with anatomical autologous bone grafting using tunnel-drilling debris, anterior knee pain shifts from an inevitable complication to an avoidable risk but a large-scale prospective studies are necessary to make it a preventable risk.
