Functional Anterior Knee Pain and Return to Sport Following Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction

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Figure 1.
Preoperative activity levels of patients stratified by activity type.
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Figure 2.
Mean visual analog scale (VAS) pain scores from baseline (preoperatively) to the 3-year postoperative follow-up. The VAS is scored on a scale of 0 to 10, with 0 indicative of no pain and 10 indicative of maximal pain.
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Figure 3.
Mean total arc of motion for patients from 2 weeks postoperatively to the 1-year follow-up.
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Figure 4.
Incidence of anterior knee pain from 2 weeks postoperatively to the 3-year follow-up. The peak incidence (28.4%) occurred at 3-month follow-up.

Table 1.

Patient Demographics and Other Procedures, n=67

Variable	Value
Age, years, mean	29.2
Body mass index, kg/m², mean	26.6
Sex
Male	32 (47.8)
Female	35 (52.2)
Knee laterality
Right	32 (47.8)
Left	35 (52.2)
Other procedures
No meniscus procedure	7 (10.4)
Meniscus repair	25 (37.3)
Medial meniscus repair	18 (26.9)
Lateral meniscus repair	13 (19.4)
Partial meniscectomy (without repair)	35 (52.2)
Medial meniscectomy	21 (31.3)
Lateral meniscectomy	40 (59.7)
Synovectomy	67 (100.0)
Plica excision	63 (94.0)

Notes: Data are presented as n (%) unless otherwise indicated. Several patients underwent surgical repair of both the medial and lateral meniscus.

Table 2.

Graft Dimensions

Table 3.

Postoperative Outcome Measures, n=67

	Postoperative Follow-Up Time Point
Outcome Measure	2 Weeks	6 Weeks	3 Months	6 Months	1 Year	3 Years
Visual analog scale pain score, mean	2.3	1.2	0.8	0.7	0.9	1.8
Presence of anterior knee pain, n (%)	6 (9.0)	10 (14.9)	19 (28.4)	8 (11.9)	4 (6.0)	5 (7.5)
Knee range of motion, degrees, mean
Extension lag	0.8	1.0	0.2	0.6	1.5
Flexion	82.9	110.8	130.8	138.2	144.0
Total arc	82.0	109.8	130.5	137.6	142.5

Note: The visual analog scale is used to score pain on a scale from 0 to 10, with 0 indicative of no pain and 10 indicative of maximal pain.

Table 4.

Patient-Reported Outcome Scores at 3-Year Follow-Up

Assessment Tool	Score, Median (Q1, Q3)
International Knee Documentation Committee Subjective Knee Evaluation Form^a	82.8 (72.7, 91.4)
Lysholm Knee Scoring Scale^b	87.0 (77.0, 93.0)
Knee Injury and Osteoarthritis Outcome Score^c
Symptoms	82.1 (75.0, 89.3)
Pain	90.6 (84.4, 96.9)
Activities of daily living	98.5 (94.1, 100)
Sports	85.0 (70.0, 95.0)
Quality of life	75.0 (56.3, 87.5)

↵^aThe International Knee Documentation Committee Subjective Knee Evaluation Form is a patient-reported outcome measure that provides an overall knee function score. It is scored on a 0 to 100 scale, with higher scores indicating higher levels of function.
↵^bThe Lysholm Knee Scoring Scale is a patient-reported outcome measure for assessing anterior cruciate ligament injuries. It is scored on a 0 to 100 scale, with higher scores indicative of greater levels of functionality and fewer disabilities.
↵^cThe Knee Injury and Osteoarthritis Outcome Score is a comprehensive assessment of knee injury and knee osteoarthritis. It is scored on a 0 to 100 scale, with 0 indicative of severe knee problems and 100 indicative of no knee issues.

Table 5.

Study Variables and Statistical Comparison of Return-to-Sport Rates

↵^aNumbers and percentage are exactly as reported in Novaretti et al.
↵^bArdern et al calculated this percentage as a pooled rate of return from meta-analysis, inclusive of studies with multiple types of anterior cruciate ligament reconstruction grafts.
↵^cStatistically significant differences in the return-to-sport rate compared to this investigation, (α=0.05).