Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 12;8(6):2325967120925482.
doi: 10.1177/2325967120925482. eCollection 2020 Jun.

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

Brittney A Hacken  1 , Lucas K Keyt  1 , Devin P Leland  1 , Matthew D LaPrade  1 , Christopher L Camp  1 , Bruce A Levy  1 , Michael J Stuart  1 , Aaron J Krych  1
Affiliations

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

Brittney A Hacken et al. Orthop J Sports Med. .

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.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: M.D.L. has a family member with the following disclosures: consulting fees from Arthrex, Linvatec, Ossur, and Smith & Nephew; research support and speaking fees from Smith & Nephew; and royalties from Arthrex, Ossur, Smith & Nephew, and Thieme. C.L.C. has received hospitality payments from Arthrex and Zimmer Biomet. B.A.L. has received research support from Arthrex, Biomet, Smith & Nephew, and Stryker; educational support from Linvatec; consulting fees from Arthrex; speaking fees from Arthrex and Smith & Nephew; and royalties from Arthrex. M.J.S. has received research support from Arthrex and Stryker and consulting fees, speaking fees, and royalties from Arthrex. A.J.K. has received research support from Aesculap/B. Braun, Ceterix, Exactech, Gemini Medical, and Histogenics; has received consulting fees from Arthrex, JRF Ortho, and Vericel; has received royalties from Arthrex; is a board member for the Musculoskeletal Transplant Foundation; and has stock/stock options in Responsive Arthroscopy. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
The donor site morbidity questionnaire that was used to measure postoperative outcomes. ACL, anterior cruciate ligament.
Figure 2.
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.
Figure 3.
Histogram depicting the distribution of postoperative outcome scores using the donor site morbidity tool.
Figure 4.
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.
See this image and copyright information in PMC

References

    1. Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am. 2004;86(10):2143–2155. - PubMed
    1. Ahmad SS, Meyer JC, Krismer AM, et al. Outcome measures in clinical ACL studies: an analysis of highly cited level I trials. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1517–1527. - PubMed
    1. Beynnon BD, Johnson RJ, Fleming BC, et al. Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am. 2002;84(9):1503–1513. - PubMed
    1. Bonatus TJ, Alexander AH. Patellar fracture and avulsion of the patellar ligament complicating arthroscopic anterior cruciate ligament reconstruction. Orthop Rev. 1991;20(9):770–774. - PubMed
    1. Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J. Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med. 2003;31(1):19–25. - PubMed

LinkOut - more resources