Olaran A, Garcia-Mansilla I. Letter to the Editor: Anterior knee pain after anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: Inevitable or avoidable with autologous bone grafting? World J Orthop 2026; 17(6): 117568 [DOI: 10.5312/wjo.v17.i6.117568]
Corresponding Author of This Article
Ignacio Garcia-Mansilla, MD, Division of Knee, Hospital Italiano de Buenos Aires, Juan Domingo Perón 4190, Buenos Aires 1109, Argentina. ignaciogmansilla@gmail.com
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Orthopedics
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letter
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Olaran A, Garcia-Mansilla I. Letter to the Editor: Anterior knee pain after anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: Inevitable or avoidable with autologous bone grafting? World J Orthop 2026; 17(6): 117568 [DOI: 10.5312/wjo.v17.i6.117568]
World J Orthop. Jun 18, 2026; 17(6): 117568 Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.117568
Letter to the Editor: Anterior knee pain after anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: Inevitable or avoidable with autologous bone grafting?
Agustina Olaran, Ignacio Garcia-Mansilla
Agustina Olaran, Ignacio Garcia-Mansilla, Division of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina
Author contributions: Olaran A designed the overall concept and outline of the manuscript; Olaran A and Garcia-Mansilla I contributed to conceptualization, writing, reviewing and editing. All authors have read and approved the final version of the manuscript.
AI contribution statement: The content was developed based on the authors’ expertise in the subject matter for which they were invited to contribute, including intellectual authorship, argumentation, and analysis of the relevant technical literature. AI tools, such as DeepL and Microsoft 365 Copilot, were used solely to assist with writing and language review, ensuring an appropriate editorial tone and clarity in the presentation of the information.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ignacio Garcia-Mansilla, MD, Division of Knee, Hospital Italiano de Buenos Aires, Juan Domingo Perón 4190, Buenos Aires 1109, Argentina. ignaciogmansilla@gmail.com
Received: December 10, 2025 Revised: December 30, 2025 Accepted: January 14, 2026 Published online: June 18, 2026 Processing time: 189 Days and 9.3 Hours
Abstract
Anterior knee pain remains one of the most persistent drawbacks of anterior cruciate ligament reconstruction using bone-patellar tendon-bone (BPTB) autografts. Traditionally viewed as an unavoidable consequence of graft harvest, anterior knee pain has led many surgeons to favor alternative graft choices despite the superior biomechanical properties of BPTB. The study published in the World Journal of Orthopedics by Byravamoni Venugopal et al challenges this paradigm by demonstrating that autologous bone grafting of the patellar and tibial donor site defects - using cancellous bone collected during tunnel drilling - can markedly reduce postoperative pain and morbidity. Their findings, showing 95.8% of patients pain-free at one year, suggest that donor site management rather than graft type may be the key determinant of postoperative comfort. While further prospective studies are needed to confirm these results, this technique represents a promising, biologically sound, and cost-effective strategy to mitigate one of the most common complications following BPTB reconstruction.
Core Tip: This study challenges the long-held belief that anterior knee pain is an inevitable consequence of anterior cruciate ligament reconstruction using bone-patellar tendon-bone grafts. By employing autologous bone grafting to fill donor site defects, the researchers demonstrate a significant reduction in postoperative anterior knee pain, with 95.8% of patients pain-free at one year. This innovative approach not only emphasizes the importance of effective donor site management but also presents a cost-effective, biologically sound strategy that could enhance patient outcomes and redefine surgical practices in anterior cruciate ligament reconstruction.
