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Donor Site Morbidity and Return to the Preinjury Activity Level After Anterior Cruciate Ligament Reconstruction Using Ipsilateral and Contralateral Patellar Tendon Autograft

A Retrospective, Nonrandomized Study

From the ATOS Clinic, Center for Knee and Foot Surgery, Sport Surgery, Heidelberg, Germany

^* Address correspondence to Hans H. Paessler, MD, ATOS Clinic, Center for Knee and Foot Surgery, Sport Surgery, Bismarckstrasse 9-15, 69115 Heidelberg, Germany (e-mail: paessler{at}atos.de).

Aim: To compare the donor site morbidity after anterior cruciate ligament reconstruction using ipsilateral and contralateral bone–patellar tendon autograft.

Study Design: Cohort study; Level of evidence, 2

Patients and Method: Between 1997 and 1999, 100 patients underwent anterior cruciate ligament reconstruction with autologous bone–patellar tendon graft. The reconstructions were performed using ipsilateral bone–patellar tendon graft in 52 patients (group Ip) and contralateral bone–patellar tendon graft in 48 patients (group Co). Group Co consisted of 2 subgroups: group CoD consisted of the donor knees (n = 48) and group Co-ACL consisted of the anterior cruciate ligament–reconstructed knees (n = 48). Mean follow-up was 39.2 months. Donor site morbidity was evaluated with a questionnaire, computerized historical data, KT-2000 arthrometer measurements, the Cincinnati score, and the Tegner score.

Results: KT-2000 arthrometer evaluation showed a mean side-to-side difference of 0.6 mm in both groups. There were no significant differences between the 2 groups concerning the Cincinnati and Tegner scores. With regard to local tenderness, a significantly higher rate was found in group Ip (59.6%) and group Co-D (58.3%) compared with group Co-ACL (6.3%). In groups Ip and Co-D, high statistically significant differences were also found according to kneeling pain (69.2% and 70.8%, respectively) and knee-walking pain (76.9% and 70.8%, respectively) compared with group Co-ACL (6.3% and 10.4%, respectively). With regard to numbness, there was no statistical significance between the rates of all 3 groups: group Ip = 75%, group Co-D = 85.4%, and group Co-ACL = 64.6%. There was one rupture of the patellar tendon and one patient with chronic patellar tendinitis, both in the donor knee of group Co-D.

Conclusion: The contralateral bone–patellar tendon graft appears to present no advantage over the ipsilateral graft, as all symptoms concerning donor site morbidity are shifted from the injured into the healthy knee, and return to activity is not more rapid.

Key Words: anterior cruciate ligament (ACL) reconstruction • patellar tendon • donor site morbidity

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