title: Quantifying the problem of kneeling after a two incision bone tendon bone arthroscopic anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  the aims of this study was to investigate the post-operative incidence of anterior knee pain and quantify the problem of kneeling in patients who have underwent anterior cruciate ligament (ACL) reconstruction with a bone tendon bone (BTB) graft.
  
  
  METHODS
  prospective study of 71 male patients who participated in competitive sports and underwent BTB ACL reconstruction using a two incision approach between August 2008 and May 2011. The patella defect was packed with bone graft, and the peritenon was preserved and repaired. A questionnaire was used to evaluate pain and kneeling capability. All patients had pre and post operative Lysholm/Tegner scores, KT1000 evaluation and hop tests to assess knee stability and function.
  
  
  RESULTS
  71 patients were operated and had a follow up of 42 months, mean age 29.8. 22 patients had anterior knee pain on kneeling, paraesthesia of anterior knee was found in 23 patients. 65 patients were still able to kneel and 6 found they were unable. 36 were able to kneel for unrestricted periods, 9 for 5-15 minutes, 15 kneel for 1-5 minutes and 5 for >1 minute. Anterior knee pain was compared to kneeling time (P=0.001). Paraesthesia and kneeling time, (P=0.001). Anterior knee pain when compared with Lysholm score (P=0.540), hop test (P=0.277), and Lachman's (P=0.254).
  
  
  CONCLUSIONS
  two incision BTB grafting of the patella and repair of the paritenon minimises the length of scar at the front of the knee. This reduces any palpable defects which could be causation factor for pain whilst kneeling. We have quantified kneeling and pain, thus aiding patients and surgeons in making the right decision for graft choice for ACL reconstruction.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, UK.
authors.forename: Osman
authors.initials: O
authors.lastname: Riaz
authors.affiliation: Department of Orthopaedics and Trauma Surgery, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, UK.
authors.forename: Sohail
authors.initials: S
authors.lastname: Nisar
authors.affiliation: Department of Orthopaedics and Trauma Surgery, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Phillips
authors.affiliation: Department of Orthopaedics and Trauma Surgery, Calderdale and Huddersfield Foundation NHS Trust, Huddersfield, UK.
authors.forename: Asim
authors.initials: A
authors.lastname: Siddiqui
keywords: ACL; anterior knee pain; kneeling