A 22-year-old female soccer player pivots and sustains a non-contact ACL injury. She later undergoes ACL reconstruction with a bone-patellar tendon-bone (BPTB) autograft. Which specific complication is MOST unique to the BPTB donor site compared to hamstring tendon graft harvest?

• A Increased risk of graft failure at 2-year follow-up
• B Anterior knee pain and kneeling discomfort from patellar tendon scarring ✓
• C Higher incidence of tunnel widening on follow-up MRI
• D Increased risk of saphenous nerve injury during harvest

Explanation

Bone-patellar tendon-bone (BPTB) autograft harvest is associated with specific donor site morbidity: anterior knee pain (patellar tendonitis, fat pad fibrosis), kneeling discomfort (due to scarring of the infrapatellar fat pad and patellar tendon), risk of patellar fracture, and rarely patellar tendon rupture. These sequelae are unique to BPTB harvest and do not occur with hamstring (gracilis/semitendinosus) harvest. Hamstring grafts have higher rates of tunnel widening due to delayed graft-to-tunnel healing and potential for hamstring weakness. The gold standard graft remains BPTB due to bone-to-bone healing.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.