Clinical comparison of the Autologous Quadriceps Tendon (BQT) and the Autologous Patella Tendon (BPTB) for the reconstruction of the Anterior Cruciate Ligament

Abstract

The use of the BPTB-autograft is a very common method for ACL reconstruction. Nevertheless, the problem of the typical donor-site-morbidity is unresolved. Recently, a transplant of quadriceps tendon, with an attached bone block (BQT) has been increasingly relied upon. The purpose of this study was to examine the clinical results of a group of patients after arthroscopic ACL reconstruction using either BPTB or quadriceps tendon autograft after a minimum follow-up of 2 years in terms of knee joint stability and function using both subjective and objective criteria. Retrospective study. A total of 260 patients with ACL ruptures were operated between 1995 and 2000; 124 received a BQT-autograft, including 8 revisions; 136 patients received a BPTB-autograft, exclusively primary interventions. The results were evaluated using the IKDC-, Noyes- and Lysholm-Scores. It was possible to re-evaluate 194 patients after a minimum follow-up period of 2 years, 64 of 260 patients (25%) were lost to follow-up. Ninety-seven percent of the operated knee joints in the BPTB-group were judged as normal or almost normal with the IKDC evaluation, as were 83% in the BQT-group (P < or = 0.001). The BQT-group showed a significantly better result in the evaluation of the donor-site-morbidity. We found no significant differences in the functional outcome according to the Lysholm- and Noyes-Score. In comparison to the results after using a BQT-transplant for reconstruction of a ruptured ACL the use of the BPTB-transplant is in favour concerning patient satisfaction and IKDC evaluation. For patients with activities involving kneeling or prolonged flexion of the knee joint BQT-transplants can be a good alternative, however.

ACL reconstruction with BPTB autograft and irradiated fresh frozen allograft

“…Many studies reported that the ACL reconstruction with BPTB autograft produced good clinical results (Harner et al, 1996;Fu et al, 2000;Deehan et al, 2000;Gorschewsky et al, 2007;Han et al, 2008). However, a desire to avoid the sacrifice of autologous tissue and to minimize surgical trauma and postoperative donor site morbidity has promoted the consideration of alternative graft sources (Stringham et al, 1996;Siebold et al, 2003;Barrett et al, 2005).…”

Outcomes Following ACL Reconstruction Utilizing the Quadriceps Tendon Autograft: A Critically Appraised Topic

“…However, there have been retrospective studies that compared QTPB and BPTB morbidities following ACLR. 13,14 The outcomes of these studies demonstrated similar graft failure rates, 13,14 and similar flexion/extension deficits. 13 However, increased anterior knee pain and donor site morbidity was greater for individuals who underwent BPTB compared with the QTPB group.…”

“…However, two retrospective studies that were not included in the CAT compared subjective patient-reported outcomes between BPTB and QTPB patients. 13 The results indicated no significant differences in Lysholm scores when compared postoperatively (BPTB = 92.8, QTBP = 91.5 13 ; BPTB = 95, QTBP = 94 14 ). Additional clinician-based outcomes were also measured in each of the studies, including laxity/ anteroposterior translation, [3][4][5][6] knee function using ROM 3,6 and one-leg hop index, 3 patellofemoral crepitus, 3 thigh girth, 4 muscle strength, 4,6 joint space narrowing, 4 anterior knee pain, 6 and the IKDC guidelines were used during physical examination.…”

MRI evaluation to predict tendon size for knee ligament reconstruction

“…Pre-operative knowledge of graft size will allow surgeons greater confidence in evaluating and counseling patients regarding graft choice. Consequently, alternative options of choosing another graft source can then be considered prior to 19,20 . The reported benefits of using the QT are that it eliminates the morbidities related to other graft options, with less reported anterior knee pain and numbness compared with PT-bone graft, as well as none of the residual cramping that can occur with hamstring tendon harvest.…”