Comparison of functional outcome between bone quadriceps tendon (BQT) and single-bundle hamstring tendon (SBHT) autograft in arthroscopic-assisted anterior cruciate ligament reconstruction cases: a prospective cohort study

Abstract

Background ACL rupture has a high morbidity in productive-age population. The increasing incidence and proper management has become a point of interest in the musculoskeletal sport injury. Choosing the best graft has become the main focus in searching for a better outcome regarding ACL reconstruction in these patient population. Currently, single bundle hamstring tendon (SBHT) autograft was preferred in Asian population compared to bone quadriceps tendon (BQT) autograft. However, there are some problems such as short and small in diameter of SBHT. This study is focused on evaluation of the clinical outcome between BQT and SBHT in arthroscopic-assisted ACL reconstruction patients. Materials and methods In this prospective cohort study, 30 subjects were divided into 2 groups (BQT and SBHT). Sampling was taken between February 2017–2018 (1 year) in one orthopaedic center. The instruments used for evaluation are rolimeter and patient-reported outcome (PRO) questionnaires (IKDC, Tegner-Lysholm, and KOOS) with data mining between 3 months, 6 months, and 1 year post operation. This study has been reported in line with the STROCSS criteria. Results Mean difference of quadriceps (3.12 ± 0.94) and hamstring (3.87 ± 0.61) in rolimeter measurement 1 year post operation is statistically significant (p = 0.015). Side-to-side difference shows better result in quadriceps (0.34 ± 0.70) compared to hamstring (0.84 ± 0.60) with p value 0.04. IKDC scores in one month (p = 0.002; CI95% [8.81–31.79]) and three months (p = 0.004; CI95% [4.85–20.39]) post operative is better in quadriceps group. Tegner-Lysholm assessment 1 month post operative showed consistent results between numeric (p = 0.004) and categoric data (p = 0.050) in quadriceps group. There was an improvement during six months and one year post operative KOOS sub-item scales; pain (p = 0.034) and symptoms (p = 0.001). Conclusion Functional outcome of patient undergoing arthroscopic-assisted ACL reconstruction is better in BQT group compared to SBHT group, both in subjective and objective parameters given.

Quadriceps tendon autograft with or without bone block have comparable clinical outcomes, complications and revision rate for ACL reconstruction: a systematic review

“…Out of 13 studies, 5 were randomized controlled trials [ 2 , 17 , 21 , 22 , 31 ], 6 were prospective cohort [ 4 , 14 , 15 , 20 , 24 , 27 ], 1 was prospective case–control [ 16 ] and 1 prospective case series [ 28 ]. Table 1 shows the characteristics of the cohorts involved in the 13 selected studies for a total of 442 patients and a summary of their data.…”

“…Table 1 shows the characteristics of the cohorts involved in the 13 selected studies for a total of 442 patients and a summary of their data. Seven studies reported the use of quadriceps tendon with bone block [ 2 , 4 , 17 , 20 , 21 , 24 , 27 ], while in six studies [ 14 – 16 , 22 , 28 , 31 ] only soft tissues quadriceps tendon was used for ACL reconstruction.…”

“…All procedures with bone block were performed with the single-bundle technique [ 2 , 4 , 17 , 20 , 21 , 24 , 27 ] except in one study, where the double-bundle technique was used [ 17 ]. In two studies an anteromedial portal technique was used for femoral tunnel placement [ 17 , 27 ], in another two studies, a transtibial technique was performed [ 2 , 21 ], while one study reported an outside-in technique [ 4 ].…”

“…In two studies an anteromedial portal technique was used for femoral tunnel placement [ 17 , 27 ], in another two studies, a transtibial technique was performed [ 2 , 21 ], while one study reported an outside-in technique [ 4 ]. For femoral fixation, two studies used a suspensory system [ 20 , 27 ], in two studies an interference screw [ 4 , 21 ] and in one study press-fit fixation [ 2 ] was used. For tibial fixation in 4 studies, an interference screw was used [ 4 , 20 , 21 , 27 ], and in one study press-fit fixation [ 2 ] was reported.…”

“…For femoral fixation, two studies used a suspensory system [ 20 , 27 ], in two studies an interference screw [ 4 , 21 ] and in one study press-fit fixation [ 2 ] was used. For tibial fixation in 4 studies, an interference screw was used [ 4 , 20 , 21 , 27 ], and in one study press-fit fixation [ 2 ] was reported. The data regarding the surgical technique and rehabilitation protocol followed in each of the examined studies are displayed in Table 2 .…”