Donor-Site Recovery after Anterior Cruciate Ligament Reconstruction with Contralateral Autogenous Patellar-Tendon Graft

OBJECTIVES: To evaluate the recovery of the donor site after ACL-reconstruction with a contralateral autogenous patellar tendon graft as compared with an ipsilateral graft. Specifically, we compared the International Knee Documentation Committee (IKDC) subjective scores between groups and compared to established normative data. Furthermore we evaluated quadriceps muscle strength between surgery groups. METHODS: Between 2007 and 2009, 279 patients who underwent primary ACL reconstruction with an autogenous patellar tendon graft from the contralateral knee met the inclusion criteria of unilateral knee involvement, no evidence of arthritic changes preoperatively, and minimum 2 year follow-up objective and subjective evaluations. A control group was obtained of 58 patients who had the same inclusion criteria, were of the same age, but underwent surgery with ipsilateral graft. Patients underwent a goal-directed and sequential postoperative rehabilitation program that emphasized controlling a hemarthrosis, obtaining full knee range of motion as soon as possible after surgery, increasing leg strength, and functional activities to return patients back to sports. The rehabilitation for the contralateral donor site emphasized high repetition/low resistance exercises beginning the day after surgery to reconstitute the patellar tendon size and strength. IKDC subjective data was compared between surgery groups and established normative data. Quadriceps muscle strength was evaluated in both knees compared to the pre-operative values obtained in the non-involved knee; strength between knees at 2 years postoperatively was also evaluated. RESULTS: When comparing quadriceps muscle strength to its pre-operative baseline value, the ipsilateral control group that had statistically significantly less strength in the ACL-reconstructed knee at 105% ± 29% compared with the contralateral group that had 114% ± 28.4% strength in the donor knee (P < .01) and 116% ± 25% strength in the ACL-reconstructed knee (P = .0339). When side-to-side strength was evaluated at 2 years post-operatively, the contralateral group had 98.4% ± 13.6% quadriceps muscle strength compared with 92.9% ± 13.0% in the ipsilateral control group (P < .01). The mean total IKDC scores obtained at the 2-year follow-up was 92.4 ± 9.6 for contralateral donor-knee, 88.8 ± 12.3 in the contralateral ACL-reconstructed knee, and 88.9 ± 11.2 for the control group ACL-reconstructed knee (p=0.960). There was also no statistical significant differences between groups for any of the IKDC sub-scores or total score (All P-values >.136; Table 1). The mean IKDC scores compared with established normative data of noninjured people of the same age and sex showed no large effect size differences between groups. CONCLUSION: With proper rehabilitation after surgery, use of a contralateral bone-patellar tendon-bone autograft with ACL reconstruction does not cause unresolved donor-site strength loss or subjective symptoms.