Preventing Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction

Abstract

We studied a group of 602 patients who had anterior cruciate ligament reconstructions between 1987 and 1992. An autogenous patellar tendon graft was used, regardless of preexisting patellofemoral pain or chon dromalacia. The surgeon and rehabilitation protocol were the same for all patients, with emphasis on ob taining full knee hyperextension postoperatively. All patients were evaluated by a questionnaire designed to determine the incidence and severity of anterior knee pain as it relates to sporting or daily living activ ities, prolonged sitting, stair climbing, and kneeling. Range of motion for the study group was recorded during physical examination. We compared the find ings with those from a control group of 122 patients who had no previous knee injury. The study group reported a mean score of 89.5 ± 12.5, compared with 90.2 ± 12.3 in the control group. Both the operative and control groups reported little or no symptoms dur ing sporting activities (94% and 92%, respectively). No differences were noted with respect to the other activ ities surveyed. These results demonstrate that anterior knee pain after anterior cruciate ligament reconstruc tion is not an inherent complication associated with patellar tendon harvesting. We suggest that the in creased incidence of anterior knee pain with an autog enous patellar tendon graft can be prevented by ob taining full knee hyperextension postoperatively. This goal can be achieved through preoperative rehabilita tion and a postoperative protocol emphasizing early restoration of full knee hyperextension.