Hamstring v patellar tendon autografts

Editor—As a patient who has had a bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction, I agree with Biau et al's findings that anterior knee pain can be troublesome at times.¹ Biau et al also emphasise the importance of discussing such potential problems preoperatively with patients, especially those from Asia. Being Indian in origin, I have had to sit cross-legged or to kneel for periods at religious or social events, and this has led to serious discomfort afterwards.

As a clinician and researcher, I note the sound methods of this meta-analysis but that the quality of the studies was generally poor. The authors do not discuss publication bias. There was also no mention of cost in the article (both financial and quality of life).

Such comparative data are probably hard to come by, but the time and effort (of patients, practitioners, and physiotherapists, etc) necessary to achieve a complete return to normal activities is significant. Most patients who undergo these procedures are young and active, so these are important considerations that I would certainly look into were I to undergo knee reconstruction now.

Figure 1.