Knee pain associated with bone–patellar tendon–bone autografts does not limit activity levels, sports participation or quality of life after ACL reconstruction
Bibliographic record
Abstract
PURPOSE: Bone-patellar tendon-bone (BPTB) and Hamstring (HT) autografts are commonly used for anterior cruciate ligament reconstruction (ACLR). Concerns exist regarding postoperative anterior knee pain (AKP) and kneeling discomfort with BPTB grafts. However, many studies solely report the presence/absence of anterior knee pain, without assessing its clinical significance in terms of functional limitation or impact on quality of life. METHODS: This study prospectively analysed 1407 patients undergoing primary ACLR with BPTB or HT autografts. Knee pain prevalence, severity, and location were measured at 6 months, 1 year, 2 years, and 5 years postoperatively using a pain questionnaire. Patient-reported measures (Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], International Knee Documentation Committee [IKDC] and Marx) and return to play (RTP) rates were also collected to evaluate knee symptoms, function and activity levels. Multivariable regression identified factors associated with knee pain at each time point. RESULTS: The mean age was 24.5 ± 7.1 years, with 74.3% male. BPTB grafts were used in 81% (n = 1145) and HT in 19% (n = 262). At 6 months, the BPTB group reported a higher prevalence of AKP (26% vs. 6%, p < 0.001). There was no difference between graft types at 1 year and 2 years postoperatively. At 5 years, the BPTB group were 1.59 times more likely to report pain, although most pain was mild and there was no significant differences in KOOS, WOMAC, IKDC, Marx scores or RTP rates. Female patients (OR 1.41, p < 0.035) and BPTB grafts (OR 1.78, p < 0.004) were associated with knee pain at 6 months. At 5 years, older age (OR 1.06, p < 0.001), BPTB grafts (OR 1.59, p < 0.027), and medial femoral condyle chondral pathology (OR 1.7, p < 0.020) increased the odds of having pain. CONCLUSION: BPTB grafts are associated with early AKP, which improves over time. AKP related to BPTB is mild and does not affect activity levels, sports participation or quality of life. Mild AKP should not deter surgeons from using BPTB autografts for ACLR, given the other advantages of this graft choice. LEVEL OF EVIDENCE: Level II, prospective study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".