Objectives: Bone-patellar tendon-bone (BPTB) autograft remains a frequently utilized technique for anterior cruciate ligament reconstruction (ACLR) due to its biomechanical properties, but is consistently associated with a high incidence of postoperative anterior knee pain (AKP). This study aims to assess the intensity of AKP in patients who underwent ACLR using the BPTB method.

Methods: We retrospectively reviewed the patients who underwent anatomical arthroscopic ACLR with BPTB autograft from 2016 to 2021 in our orthopedic medicine center. Outcome measures included range of motion (ROM), presence and location of pain and discomfort, along with completion of the Lysholm, International Knee Documentation Committee (IKDC), and Visual Analog Scale (VAS) questionnaires by all patients.

Results: AKP was reported by 11.5% of patients, with only 6.8% experiencing severe pain during kneeling. Mild or greater kneeling pain was reported by 38.8%, while 61.1% reported no kneeling pain. Mean VAS pain score was low (1.6/10), and functional scores were favorable (Lysholm 91.9 ± 11.2; IKDC 85.2 ± 15.0). Notably, AKP intensity and kneeling pain decreased significantly over time (P=0.004 and P=0.05, respectively). Older age correlated with lower IKDC scores (P=0.015). ROM was preserved in 92.5% of patients, with no patellar fractures observed.

Conclusion: Although AKP remains a notable complication following ACLR with BPTB autograft, its prevalence and severity are relatively low in this cohort, and symptoms tend to improve with time. These findings support the continued use of BPTB grafts, particularly when early stability and return to high-level activities are prioritized. Careful surgical technique and rehabilitation focusing on full knee extension may mitigate AKP risk.