Harvesting a second graft from the extensor mechanism for revision ACL reconstruction does not delay return of quadriceps function

Abstract

PurposeThe purpose of this study was to evaluate whether harvesting a second graft from the ipsilateral extensor mechanism adversely affects clinical outcomes in revision anterior cruciate ligament (ACL) reconstruction. MethodsA retrospective review of 34 patients undergoing revision anterior cruciate ligament (ACL) reconstruction with either quadriceps tendon (QT) autograft or bone–tendon–bone (BTB) autograft was conducted. Patients with two grafts (BTB+QT) from the extensor mechanism were matched based on age, laterality, and sex to patients who had primary reconstruction with hamstring (HS) autograft followed by revision with either BTB or QT autograft (HS+QT/BTB). Return of quadriceps function was assessed with time to return to jogging in a standardized rehab protocol or time to regain 80% quadriceps strength. Secondary outcomes included International Knee Documentation Committee (IKDC) and Marx scores at 12‐month follow‐up and return to sport. ResultsThere were no significant differences in return to jogging or 80% quadriceps strength (HS 149.5 ± 38.2 days, BTB+QT 131.7 ± 40.1 days, n.s.), number able to return to sport (HS 62%, BTB+QT 93%, n.s.), months to return to sport (HS 10.6 ± 1.4, BTB+QT 10.5 ± 2.3, n.s.), return to pre‐injury level of competition (HS 62%, BTB+QT 73%, n.s.), or IKDC (HS 77.2 ± 16.4, BTB+QT 74.8 ± 23.9, n.s.) and Marx scores (HS 9.2 ± 5.3, BTB+QT 8.0 ± 3.7, n.s.) at one‐year follow‐up. ConclusionThe main finding of the present study was that outcomes for patients who underwent revision ACL reconstruction with a second extensor mechanism autograft were comparable to those seen for patients who underwent revision ACL reconstruction with extensor mechanism autograft after primary ACL reconstruction with hamstring autograft. By better understanding the consequences of harvesting a second graft from the extensor mechanism, surgeons can better decide what graft to use in revision ACL reconstruction. Level of evidenceLevel III.

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

“…Previously described extensor mechanism strength deficits associated with QT harvest appear less pronounced than originally thought; and while extensor strength is inferior to HT at 6 months, strength measurements are equivalent at 1 year [23, 29]. While concerns exist regarding a double hit to the extensor mechanism when using a BTB graft followed by a QT graft or vice versa, multiple studies have demonstrated there is no appreciable difference in extension strength with or without a use of a second extensor mechanism graft in RACLR [26, 56].…”