Letter to the Editor: Anterior knee pain in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft and autologous bone grafting

Core Tip

Core Tip: We read with interest the article by Byravamoni Venugopal et al addressing anterior knee pain following bone-patellar tendon-bone anterior cruciate ligament reconstruction using autologous bone grafting, an important issue related to donor-site morbidity. While the technique is innovative and cost-effective, several methodological limitations may affect interpretation of the findings. The exclusive reliance on the Kujala score, which is subjective and prone to ceiling effects, limits its ability to accurately quantify anterior knee pain severity. The retrospective design with telephonic follow-up further increases the risk of recall bias, particularly for activity-specific pain such as kneeling or squatting. Additionally, the lack of detailed reporting on associated intra-articular injuries introduces potential confounding, as these pathologies can independently influence postoperative pain and function. Finally, the absence of a control group restricts causal inference regarding the true benefit of donor-site bone grafting. Prospective controlled studies using pain-specific outcome measures are needed to confirm the clinical efficacy of this technique.