Double-Layered Quadriceps Tendon Autografts Provide Lower Failure Rates and Improved Clinical Results Compared With Hamstring Tendon Grafts in Revision ACL Reconstruction

Abstract

Background: We developed a quadriceps-tendon graft technique using a double-layered, partial-thickness, soft tissue quadriceps tendon graft (dlQUAD) for anterior cruciate ligament reconstruction (ACLR). This technique allows simple femoral loop button fixation and a limited harvest depth of the quadriceps tendon. Purpose: To evaluate the outcome of patients undergoing revision ACLR using the dlQUAD technique compared with a hamstring tendon graft (HT). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 114 patients who underwent revision ACLR between 2017 and 2018 were included in this retrospective case series. At a mean follow-up of 26.9 ± 3.7 months (range, 24-36), 89 patients (dlQUAD: n = 43, HT: n = 46) were clinically examined. In addition, patients completed the Lysholm score, Tegner activity scale, subjective International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score, and visual analog scale (VAS) for pain. Postoperative failure of the revision ACLR was defined as a side-to-side difference (SSD) in Rolimeter testing ≥5 mm or a pivot-shift grade of 2 or 3. Results: Nine patients (10.1%) were identified with a failed revision ACLR. There was a significantly lower failure rate with dlQUAD versus the HT group (2.3% vs 17.4%; P = .031). The mean postoperative SSD was significantly less in the dlQUAD group (1.3 ± 1.3 mm [range, 0-5] vs 1.8 ± 2.2 mm [range, 0-9]; P = .043). At the latest follow-up, Tegner and IKDC scores significantly improved in the dlQUAD group compared with the HT group (Tegner: 5.8 ± 1.8 vs 5.6 ± 1.5; P = .043; IKDC: 83.8 ± 12.2 vs 78.6 ± 16.8; P = .037). The pain VAS score was also significantly reduced in the dlQUAD group compared with the HT group (0.9 ± 1.1 vs 1.6 ± 2.0; P = .014). Conclusion: The dlQUAD and HT techniques both demonstrated significant improvement of preoperative knee laxity and satisfactory patient-reported outcome measures after revision ACLR. Compared with the HT grafts, the dlQUAD technique showed lower failure rates and small increases in Tegner and IKDC scores.

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.…”

“…Side‐to‐side differences (STSD) measured by KT‐1000, KT‐2000, or Rolimeter arthrometers were reported in 6/9 studies [3, 12, 15, 20, 26, 43]. The mean weighted STSD was 1.7 mm (SD = 0.6) and 2.1 mm (SD = 0.5) for QT and HT, respectively.…”

“…Donor site morbidity was reported in three studies, with no studies reporting the rate of donor site morbidity in BTB [12, 15, 20]. QT donor site pain rates were 14.6% (SD = 9.7) versus 23.6% (SD = 14.1) in HT with no significant difference between grafts (Fig.…”

Primary Versus Revision ACL Reconstruction Using Quadriceps Autograft: A Matched-Control Cohort Study

“…31 Previous studies found similar functional outcomes with QT and HT autografts for revision reconstruction. 2,13 Another study 7 reported improved functional outcomes with QT compared with HT autograft in revision ACL reconstruction. Hunnicutt et al 16 demonstrated significant improvement in functional outcomes from the preoperative to postoperative period with QT autograft in revision ACL reconstruction.…”

Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction

“…Importantly, both techniques resulted in good to excellent clinical outcome as compared with related studies. 2,5,6,9 A recent systematic review reported a mean Lysholm score of 88.9, a subjective International Knee Documentation Committee score of 83.3, and a Knee injury and Osteoarthritis Outcome Score of 68.3 for Sport/Recreation at final midterm follow-up. 9 However, it is known that by first-time revision ACLR the outcome critically depends on concomitant injuries, patient age, sporting demands, and follow-up, which compromises this comparison.…”