Risk of Patellar Tendon Tear Following Bone-Patellar Tendon-Bone ACL Reconstruction

Prevention Strategies

The American Academy of Orthopaedic Surgeons (AAOS) guidelines recognize that BPTB autografts have advantages in reducing graft failure risk but may increase anterior or kneeling pain compared to hamstring grafts 1, 2
Early mobilization should be implemented with caution, monitoring for signs of donor site pain or weakness 3

For patients at higher risk of complications, non-surgical management of ACL tears may be appropriate 4
For younger, active patients requiring reconstruction, the choice between BPTB and hamstring autografts should consider the relative risks and benefits 1, 2
When BPTB grafts are used, rehabilitation protocols should include specific protection strategies for the donor site 3

Open kinetic chain exercises for BPTB grafts can be started from 4 weeks postoperative in a restricted ROM of 90-45° with extra resistance allowed, but this must be balanced against donor site protection, as recommended by the British Journal of Sports Medicine 5, 6
Closed kinetic chain exercises should be prioritized from week 2 postoperative to mitigate patellofemoral stress while protecting the patellar tendon donor site, according to the British Journal of Sports Medicine 7
Immediate knee mobilization within the first week is critical to prevent extension deficits and arthrofibrosis, but must be performed without excessive loading of the extensor mechanism, as suggested by the British Journal of Sports Medicine 7