ISAKOS: 2019 Congress in Cancun, Mexico

2019 ISAKOS Biennial Congress ePoster #821


Anterior Knee Pain in ACL Reconstruction with BTB Graft - Is It a Myth?: Comparative Outcome Analysis with Hamstring Graft in 1,250 Cases

Arumugam Sivaraman, MS(Orth), AB(IM)(USA), FRCS(Glasg), Chennai, Tamilnadu INDIA
Prakash Ayyadurai, MS, Chennai, Tamilnadu INDIA
Suresh Perumal, MS(Orth), Chennai, Tamilnadu INDIA
Parthiban Jeganathan, MS, Chennai, tamilnadu INDIA
Janani Gopalakrishnan, MD (Sports Medicine), Chennai, Tamilnadu INDIA
Sivaruban S., MD, Chennai, Tamilnadu INDIA
Sai Adhitya, MD, Chennai, Tamilnadu INDIA
Thiagarajan Alwar, MD, Chennai, Tamilnadu INDIA

Center for Sports Science, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamilnadu, INDIA

FDA Status Not Applicable


Incidence of post operative anterior knee pain in ACL reconstruction with BTB graft is over estimated in the literature and actually its incidence is same as that of hamstring graft if good surgical technique is used for harvesting the BIB graft.



High incidence of post-operative knee pain has been quoted as the main disadvantage of BTB graft in the literature. BTB graft is remerging as preferred graft in ACL reconstruction in recent years mainly due to possibility of early aggressive rehabilitation, bone to bone healing and it’s ribbon like anatomy similar to native ACL. At our centre we overcome the problem of anterior knee pain by harvesting the BTB graft by mini open mobile window technique.


Aim of this study was to investigate the post-operative incidence of anterior knee pain with bone tendon bone (BTB) graft in comparison with hamstring graft in patients who have underwent anterior cruciate ligament (ACL) reconstruction.

Materials And Methods

Inclusion criteria: All skeletally matured patients with isolated ACL tear are included. Exclusion criteria: Patients with multiple ligament injuries, meniscal tear, cartilage injury and preoperative anterior knee pain are excluded.
1250 patients underwent ACL reconstruction from 2008 to 2015 with mean age of 29 years. Of which 622 patients had BTB graft and 628 had Hamstring graft. All BTB graft harvested by a standardized mini open mobile window technique by the same surgeon and at our centre. All patients were evaluated with a minimum follow up of 18 months using Lysholm knee score and IKDC score.


A total of 79 patients (6.32%) had anterior knee pain. 41 patients (6.59%) in BTB group and 38 patients (6.05%) in Hamstring group had symptoms. While IKDC score of Grade A is 91% with BTB graft and 83% with hamstring graft.


BTB graft harvested by a mini open mobile window technique have low incidence of anterior knee pain as of hamstring graft.