# Long‐term results of anterior cruciate ligament reconstruction using the medial third of the patellar tendon

## TL;DR

This study shows that using part of the patellar tendon for ACL surgery leads to good long-term knee function and low pain for most patients.

## Contribution

The study provides long-term clinical and radiological outcomes of a specific ACL reconstruction technique using the medial third of the patellar tendon.

## Key findings

- Low incidence of donor-site knee pain (7.5%) and kneeling pain (17.5%) in long-term follow-up.
- Excellent anterior-posterior stability with no significant side-to-side differences in anterior tibial translation.
- Approximately 55% of patients had better knee function than age-matched populations, and 75–80% met established performance thresholds.

## Abstract

To report long‐term outcome of anterior cruciate ligament reconstruction (ACLR) using the medial third of the patellar tendon in terms of knee function evaluated with clinical assessments, patient‐reported outcomes (PROs) and radiological examinations.

Forty patients were retrospectively evaluated 16.8 ± 0.3 (range 16.2–17.4) years after the index operation for anterior knee pain, side‐to‐side difference in anterior tibial translation (ATT), Lysholm score, Tegner score, subjective International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) and radiographic evidence of osteoarthritis (Kellgren–Lawrence osteoarthritis [OA] grading).

Incidence of donor‐site knee pain was 7.5% and the severity of the pain ranged 0.5–5.5 on visual analogue scale. Incidence of kneeling pain was 17.5% and the severity of pain ranged 3–7. There were no evidence for side‐to‐side differences in ATT (operated: 2.0 ± 0.7 vs. intact: 2.0 ± 0.9, p = 0.867). Lysholm had very large correlation with KOOSQoL (0.77 [0.58; 0.90], p < 0.001). IKDC had very large correlations with KOOSsports and KOOSQoL (0.75 [0.56; 0.87], p < 0.001 and 0.70 [0.48; 0.85], p < 0.001). KOOSsports and KOOSADL had the strongest correlation (0.79 [0.60; 0.91], p < 0.001). Approximately 55% of the sample had IKDC Z‐score higher than age‐matched population average and approximately 75%–80% of the sample was above the established PASS thresholds. The operated side exhibited more pronounced progression of knee osteoarthritis (higher K‐L grade) (χ
2 = 12.9, p = 0.002); however only five knees in total (four operated, one intact) had Grade 2 radiographic OA.

Long‐term clinical outcomes following ACLR with the medial third of the patellar tendon demonstrate a low incidence of anterior knee pain, excellent anterior‐posterior stability and low rate of mild radiographic osteoarthritis. The majority of patients had achieved acceptable knee function and symptom resolution. These findings suggest that the medial third of the patellar tendon autograft is a reliable option for achieving sustained knee function and high patient satisfaction in the long term.

Level IV.