Donor site morbidity is higher when comparing bone-tendon-bone vs 4-strand semitendinosus/gracilis & all-inside 4-strand semitendinosus for anterior cruciate ligament reconstruction

Objectives: To study pain and sensory alterations of 75 (three cohorts of 25 patients) patients that underwent different anterior cruciate ligament reconstruction (ACLR) techniques. The cohorts were divided in the bone-patellar tendon-bone (BTB) autograft, the quadruple strand semitendinosus/gracilis (4ST/G) autograft and the all-inside quadruple strand semitendinosus autograft cohort. Methods: We conducted a retrospective study to evaluate pain and sensory alterations after surgery. All these patients followed a similar rehabilitation protocol, being 2 years the minimal follow-up time. Pain was characterized by duration and anatomical location and sensory deficits were evaluated concerning duration and affected area. Patients also scored on three different subjective tests: knee walking test (KWT); Lysholm knee scoring scale (LKSS), and International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and were divided according to its Tegner activity level scale (TALS). Results: The mean anterior knee pain (AKP) duration amongst the three cohorts was 1.8 + 4.5 months and was smaller in the 4ST/G cohort. The majority of patients of the BTB cohort located pain on the patellar tendon, while patients in the 4ST/G and all-inside cohorts referred that it was diffuse. At 15 days' post-surgery, hypoesthesia was reported by 56% patients and was higher on the BTB cohort and lower in the all-inside cohort. At 2-year follow-up, the all-inside cohort had no patients with hypoesthesia. In the BTB cohort, the sensitive alterations were only located on the area innervated by the infra-patellar branch of the saphenous nerve (IPBSN). The 4ST/G cohort located the hypoesthesia in the area innervated by the IPBSN and in the area of the lateral sural cutaneous nerve (LSCN). The all-inside group located the sensitive alterations mostly in the LSCN. The KWT was painful in BTB and 4ST/G patients and reported 0% for the allinside cohort. No statistic significant relevance was found for the IKDC-SKF and LKSS. Conclusions: All cohorts referred pain and sensitive alterations. Using BTB autograft for ACLR seems to condition a higher number of anterior knee pain and hypoesthesia on medium postoperative follow-up and KWT was more often reported. The 4ST/G group had the smallest duration of AKP. The all-inside cohort showed, globally, a lower number of complaints and a shorter time of symptom persistence, namely in terms of sensory deficits. Level of evidence: III.