title: Pain Assessment After Anterior Cruciate Ligament Reconstruction: Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain.
  
  
  OBJECTIVE
  To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone-patellar tendon-bone (BTB) versus hamstring tendon (HS) autograft.
  
  
  METHODS
  Cohort study; Level of evidence, 2.
  
  
  METHODS
  A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate. The primary outcome of the study was postoperative pain levels (visual analog scale), which were collected immediately after surgery and for 3 days postoperatively. Secondary outcome measures included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, reported breakthrough pain, and calls to the physician.
  
  
  RESULTS
  Patients treated with BTB had increased pain when compared with those treated with HS in the acute postoperative period (mean ± SD: day 0, 6.0 ± 1.7 vs 5.2 ± 2.0 [P= .066]; day 1, 5.9 ± 1.7 vs 4.9 ±1.7 [P= .024]; day 2, 5.2 ± 1.9 vs 4.1 ± 2.0 [P= .032]; day 3, 4.8 ± 2.1 vs 3.9 ± 2.3 [P= .151]). There were also significant increases in reported breakthrough pain (day 0, 76% vs 43% [P= .009]; day 1, 64% vs 35% [P= .003]) and calls to the physician due to pain (day 1, 19% vs 0% [P= .041]) in the BTB group. There were no significant differences in narcotic requirements or sleep disturbances. Overall, the BTB group reported significantly less satisfaction with pain management on days 0 and 1 (P= .024 and .027, respectively).
  
  
  CONCLUSIONS
  A significant increase in acute postoperative pain was found when performing ACL reconstruction with BTB compared with HS. Patients treated with BTB were more likely to have breakthrough pain, decreased satisfaction with their pain management, and to contact their physician due to pain. These findings suggest a difference in early postoperative pain between the 2 most common graft options for ACL reconstruction. Patients should be informed of the differences in acute postoperative pain when deciding on graft choice with their physician.
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Kelechi R
authors.initials: KR
authors.lastname: Okoroha
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Keller
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Edward K
authors.initials: EK
authors.lastname: Jung
authors.affiliation: School of Medicine, Wayne State University, Detroit, Michigan, USA.
authors.forename: Lafi
authors.initials: L
authors.lastname: Khalil
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Marshall
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Kolowich
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Moutzouros
keywords: anterior cruciate ligament; anterior cruciate ligament reconstruction; autograft; bone–patellar tendon–bone; hamstring tendon; knee arthroscopy; pain control