Graft-Site Morbidity in Anterior Cruciate Ligament (ACL) Reconstruction: A Scoping Review of Assessment Techniques and Outcomes

Graft-site morbidity is a critical yet often overlooked aspect of anterior cruciate ligament reconstruction (ACLR). While autografts such as bone-patellar tendon-bone (BPTB) and quadriceps tendon (QT) have been shown to provide effective mechanical stability, the functional and quality-of-life outcomes associated with graft harvesting location warrant greater attention. This scoping review evaluates the existing methodologies for assessing graft-site morbidity, focusing on anterior knee pain, paresthesia, and muscle deficits. Articles were screened from January 1, 2000, to June 12, 2024, returning 609 unique references to graft-site morbidity. A systematic search identified 43 studies meeting inclusion criteria, revealing significant variability in assessment methods and reporting standards. This review underscores the need for a uniformly administered series of techniques to measure graft-site morbidity, enabling meaningful comparisons and improving patient-centric surgical decision-making. Future investigations should prioritize standardizing assessment tools to assess graft selection and optimize holistic patient outcomes.