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.

Keywords: ACL; autograft harvest; donor site morbidity; outcome score; patellar tendon.

Figure 1.

The donor site morbidity questionnaire that was used to measure postoperative outcomes. ACL, anterior cruciate ligament.

Figure 2.

Left radiograph shows tibial and patellar donor sites at the time of surgery. Right radiograph shows incorporation of the bone graft at both the patella and tibia at 2 years postoperatively.

Figure 3.

Histogram depicting the distribution of postoperative outcome scores using the donor site morbidity tool.

Figure 4.

Intrapatient postoperative outcomes measured via the donor site morbidity (DSM), Lysholm, and International Knee Documentation Committee (IKDC) scores, with each line graphically representing an individual patient. Within each patient, all 3 scores were generated at the same time point.