Comparing Knee Laxity After Anatomic Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Versus Semitendinosus Tendon Graft

Abstract

Background: The choice of graft in anterior cruciate ligament (ACL) reconstruction is still under discussion. The hamstrings are currently the most used grafts for primary ACL reconstruction in Europe. However, increased interest has arisen in the quadriceps tendon (QT) as an alternative autologous graft option for primary ACL reconstruction. Purpose: To evaluate knee stability and the subjective outcome after ACL reconstruction using either autologous QT graft in implant-free femoral press-fit fixation technique or semitendinosus tendon (ST) graft. Study Design: Cohort study; Level of evidence, 2. Methods: We evaluated 50 patients who underwent ACL reconstruction, including 25 patients who received autologous ipsilateral QT graft (QT group) and 25 patients who received the ipsilateral ST graft (ST group). The follow-up for this prospective comparative study was at least 2 years after surgery, comprising KT-1000 arthrometer testing, pivot-shift test, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and rerupture rate. Results: The mean patient age was 31.72 years (9 women, 16 men) in the QT group and 32.08 years (13 women, 12 men) in the ST group. The mean ± standard deviation postoperative side-to-side difference assessed using KT-1000 arthrometer was 1.56 ± 1.56 mm for the QT group and 1.64 ± 1.41 mm for the ST group, with no significant difference. No significant difference was found on any of the KOOS subscale scores ( P = .694) or the Lysholm score ( P = .682). No rerupture or positive pivot-shift test occurred during follow-up. No difference was found in donor-site morbidity between the study groups. Conclusion: Clinical outcomes were not significantly different between QT and ST grafts in the current study. Thus, the QT may serve as a good alternative graft for primary ACL reconstruction.

Re-rupture rate and the post-surgical meniscal injury after anterior cruciate ligament reconstruction with the Press-Fit-Hybrid®-technique in comparison to the interference screw technique: a retrospective analysis of 200 patients with at least 3 years follow-up

“…Aiming for a reduction in meniscal lesion post-surgery is described to be related to the method used [43] and is a major reason to change the surgical procedure. In our study, pre-existing medial and lateral meniscal lesions and cartilage lesions were similarly distributed between the 2 groups-and as reported previously [19,27,28,43], therefore did not contribute to differences in the final outcome [20]. But as described by Ahlen et al [2] there is a significant higher number of medial meniscal lesions in the IF-group, when patients were operated more than 180 days after injury.…”

“…Previous studies report a re-rupture rate for the interference-screw-technique of 9-11%, [43] 14.5%, [39] 14.7% [20], 16% [35], and for press-fit-technique with Press-Fit-Hybrid®-group; IF: Interference-screw-group) There is no difference in patient age between the IF and PFH in the norupture group (p = 0.59889), and between the 2 re-rupture groups (p = 0.18599) but there is significant difference between patients with rupture and patients without rupture in the Press-Fit-Hybrid® group (p = 0.00873), presented as mean ± SD and median quadriceps-tendon-patellar-bone of 9% [6], which is above the percentage observed in the presented study, with 4% and 9% for the PFH-group and IF-group, respectively. Kampinski et al [27] did not observe any rerupture in a small group of patients, when using the interference screw technique with hamstring tendon or the press fit technique on one side with quadriceps tendon, but the follow up time was only 2 years. Due to the low number of re-ruptures in the control (IF)-group, even with a decrease of re-ruptures to 44% in the PFH-group, significant differences could not be shown.…”

“…Appropriate indications and precise surgical techniques are crucial to ensure postoperative stability [ 18 ]. The restoration of normal knee joint kinematics reduces the risk of subsequent meniscal lesion and improves healing after meniscal refixation [ 27 , 45 ]. The most commonly used method is the interference-screw-technique, but it has been associated with risks of intra-operative graft damage and secondary graft damage caused by screw misplacement [ 41 ].…”

Technique of ACL Reconstruction With Autologous Quadriceps Tendon Bone Graft and Femoral Press Fit Fixation

“…Regarding patient outcomes there are 2 studies which examined the exact surgical technique which is presented in this video article. 2,5 One study was published about the use of QT bone graft in primary ACL reconstruction and the other study focused on the results of revision ACL reconstruction. 2,5 In both studies, there was no significant difference regarding the assessment of postoperative patient reported outcome measures such as Lysholm score and Knee Osteoarthritis Outcome Score (KOOS) and instrumental knee laxity measurement (KT 1000) between patients treated with autologous QT and hamstring grafts.…”

“…9 Second, the graft is predictable in length and diameter, which is not the case with patellar tendon and hamstrings. 5 Third, there is less postoperative weakness in ACL agonists than after harvesting of hamstring tendons, with low donor side morbidity. 2 What is special about this ACL reconstruction technique?…”