All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up

Abstract

Background: Revision anterior cruciate ligament (ACL) reconstruction is being performed at an increasing rate. Previous literature has suggested that autograft ACL reconstruction is a better option than allograft in revision surgery, although the optimal autograft choice remains unknown. The all–soft tissue quadriceps tendon (ASTQT) autograft has been found to be an effective option for primary ACL reconstruction. However, few studies have evaluated ASTQT autograft in revision ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to evaluate the ASTQT autograft in revision ACL reconstruction in athletes compared with bone–patellar tendon–bone (BTB) autograft. We hypothesized that the ASTQT autograft would lead to similar return to play, time to return to play, retear rate, and patient-reported outcomes compared with BTB autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed on all athletes undergoing revision ACL reconstruction between August 2013 and December 2019 at a single institution. Patients participating in high school or college athletics undergoing first-time revision with either ASTQT or BTB autograft with ≥2 years of follow-up were included. Demographic variables, complications, return to sports, and outcome scores including the International Knee Documentation Committee (IKDC) and Lysholm were collected and compared between the 2 cohorts. Results: A total of 58 revision ACL reconstructions were included, with 32 in the ASTQT cohort and 26 in the BTB cohort. Return to sports at the same level occurred in 62.5% of the ASTQT group and 53.8% of the BTB group. The ASTQT group returned to sports significantly faster than the BTB group (8.9 vs 10.3 months; P = .020). There was no difference in retear rates (3.1%, ASTQT; 7.7%, BTB) or other complications between the 2 groups. The IKDC scores were significantly higher at the 6- and 12-month follow-up for the ASTQT autograft group compared with the BTB group (6 months: ASTQT, 71.3; BTB, 61.7, P = .001; 12 months: ASTQT, 82.7; BTB, 78.6; P = .021). Lysholm scores were also greater in the ASTQT cohort at these time points (6 months: ASTQT, 75.1; BTB, 63.6; P < .001; 12 months: ASTQT, 82.0; BTB, 74.5; P < .001). However, IKDC and Lysholm scores were similar between both groups at final follow-up (IKDC: ASTQT, 82.9; BTB, 81.7; P = .344; Lysholm: ASTQT, 83.0; BTB, 81.0; P = .104) There was no significant clinical difference in the absolute difference in scores or rate of achieving clinical thresholds between the 2 cohorts. Conclusion: ASTQT autograft for revision ACL in athletes has similar outcomes compared with BTB autograft. However, the ASTQT may possibly afford quicker return to sports and better early improvements in patient-reported outcomes that normalize by 1 year. The soft tissue quadriceps autograft should be considered a viable graft option in revision ACL reconstruction in athletes.

Quadriceps tendon autograft has similar clinical outcomes when compared to hamstring tendon and bone–patellar tendon–bone autografts for revision ACL reconstruction: a systematic review and meta‐analysis

“…Nine studies met inclusion criteria for this systematic review with a total patient population of 606, including 349 QT, 169 HT, and 88 BTB RACLR (Fig. 1) [3, 6, 12, 15, 20, 26, 39, 43, 60]. Average follow‐up ranged from 24 to 52.3 months.…”

“…Barie et al . did not demarcate QT versus HT ruptures in their analysis, and therefore, these results could not be included in analysis [3, 6, 12, 15, 20, 26, 39, 43]. The combined weighted mean failure rates were: 7.6% QT (SD = 5.2), 13.3% HT (SD = 8.0), and 8.7% BTB (SD = 1.0).…”

“…3; n.s.). Subjective IKDC scores were reported in four studies [3,6,12,26]. Weighted averages were 82.3 (SD = 1.6) for QT and 80.1 (SD = 1.7) for HT and 81.7 (SD = 5.5) for BTB.…”

“…Objective failure in this study was defined as re-rupture, additional revision surgery, KT side-to-side difference > 5 mm or pivot-shift grade ≥ 2 in this systematic review, as previously described by Noyes et al [44] Failure rate was reported in 7/9 studies for 444 patients. Barie et al did not demarcate QT versus HT ruptures in their analysis, and therefore, these results could not be included in analysis [3,6,12,15,20,26,39,43]. The combined weighted mean failure rates were: 7.6% QT (SD = 5.2), 13.3% HT (SD = 8.0), and 8.7% BTB (SD = 1.0).…”

Anterior cruciate ligament failure and management

“…The quadriceps tendon with or without a bone block is increasingly being used as an alternative to BPTB. The low complication rate and the good midterm outcomes support this choice, but the long-term benefits are yet to be demonstrated ( 90 , 91 ). Hamstring tendons remain a valuable option even in revision procedures.…”