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Anterior Knee Pain with Special Emphasis on the Clinical, Radiographic, Histological, Ultrastructural, and Biochemical Aspects After Anterior Cruciate Ligament Reconstruction Using Autografts

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Anterior Knee Pain and Patellar Instability

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Abstract

Postoperative donor site morbidity and anterior knee pain following ACL surgery may result in substantial impairment for the patient. The selection of graft, surgical technique, rehabilitation program as well as concomitant injuries can affect the occurrence of undesirable pain conditions.

The loss or disturbance of anterior sensitivity caused by intraoperative injury to the infrapatellar nerve(s) in conjunction with patellar tendon harvest is correlated with donor site discomfort and an inability to kneel and knee walk.

Efforts should be made to spare the infrapatellar nerve(s) during ACL reconstruction using patellar tendon autografts and hamstring autografts. Reharvesting the patellar tendon cannot be recommended due to significant clinical, radiographical, histological, and ultrastructural abnormalities several years after harvesting and also after reharvesting its central third. Patients who regain full range of motion and strength after the use of any type of autograft are less likely to have anterior knee pain problems.

Since randomized controlled trials have shown that the laxity measurements and clinical results following ACL reconstruction using hamstring tendon autografts are similar to those of patellar tendon autografts, we recommend the use of hamstring tendon autografts due to fewer donor-site problems.

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Acknowledgment

The authors thank Catarina Kartus for the illustrations.

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  1. Orthopaedic Department, University of Gothenburg, NU-Hospital Organization, Trollhättan/Uddevalla, Sweden

    Jüri Kartus

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  1. Jüri Kartus
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  2. Lars Ejerhed
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Correspondence to Jüri Kartus .

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    Vicente Sanchis-Alfonso

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Kartus, J., Ejerhed, L., Movin, T. (2011). Anterior Knee Pain with Special Emphasis on the Clinical, Radiographic, Histological, Ultrastructural, and Biochemical Aspects After Anterior Cruciate Ligament Reconstruction Using Autografts. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, London. https://doi.org/10.1007/978-0-85729-507-1_19

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