Low surgical routine increases revision rates after quadriceps tendon autograft for anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Registry

Lind, Martin; Strauss, Marc; Nielsen, Torsten Grønbech; Engebretsen, Lars

doi:10.1007/s00167-020-06220-0

Cited by 40 publications

(40 citation statements)

References 26 publications

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“…This ethos may have some merit when reviewing the Danish registry outcomes where Lind et al reported a high graft failure rate (6.4%) in ACLR with QT autograft by low volume ACLR centres (< 100 QT autograft ACLR) and comparable graft failure rates between QT autograft ACLR in high volume centres (> 100 ACLR) (2.9%), HT autograft (2.2%) and PT autograft (3.7%). 43 Surgeons should therefore maintain expertise in several techniques or refer patients to another specialist if the patient requests or needs an alternative graft choice.…”

Section: Discussionmentioning

confidence: 99%

Current concepts in graft selection for anterior cruciate ligament reconstruction

et al. 2021

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Graft selection for anterior cruciate ligament reconstruction (ACLR) is important for optimizing post-operative rehabilitation, facilitating return to full sporting function and reducing the risk of complications. The most commonly used grafts for ACLR include hamstring tendon autografts, bone–patellar tendon–bone autografts, quadriceps tendon autografts, allografts and synthetic grafts. This instructional review explores the existing literature on clinical outcomes with these different graft types for ACLR and provides an evidence-based approach for graft selection in ACLR. The existing evidence on the use of extra-articular tenodesis to provide additional rotational stability during ACLR is also revisited. Cite this article: EFORT Open Rev 2021;6:808-815. DOI: 10.1302/2058-5241.6.210023

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Section: Discussionmentioning

confidence: 99%

Current concepts in graft selection for anterior cruciate ligament reconstruction

et al. 2021

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“…A registry study published by Lind et al 21 showed higher failure rates for quadriceps tendon versus HT, but a study published shortly afterward by the same study group demonstrated that high-activity clinics, defined as clinics that performed >100 ACLRs per year, showed similar revision outcomes for quadriceps, hamstrings, and patellar tendon grafts, while clinics that performed <100 ACLRs (low-activity clinics) showed higher failure rates for quadriceps grafts. 20 They concluded that the higher failure rates for quadriceps tendon autografts could be due to a lower surgical routine in low-activity clinics. 20 A recent study by our research group in a different study population showed lower, but not statistically significant, failure rates for quadriceps tendon versus HT or BPB (N = 111; failure rates: Quad, 6.7%, HT, 9.4%, BPB, 18.8%).…”

Section: Discussionmentioning

confidence: 99%

“… 20 They concluded that the higher failure rates for quadriceps tendon autografts could be due to a lower surgical routine in low-activity clinics. 20 A recent study by our research group in a different study population showed lower, but not statistically significant, failure rates for quadriceps tendon versus HT or BPB (N = 111; failure rates: Quad, 6.7%, HT, 9.4%, BPB, 18.8%). 2 In the largest cohort study published to date by Runer et al, 34 a significantly higher risk of revision surgery was reported for HT autografts.…”

Section: Discussionmentioning

confidence: 99%

“…3 There is currently no consensus in the literature about the superiority of the HT or the quadriceps tendon in terms of failure rates. 19,20 In a systematic literature review and meta-analysis by Nyland et al, 28 quadriceps tendon autografts had less pivot shift and lower failure rates than HT autografts. A meta-analysis by Mouarbes et al 26 showed better functional outcomes for quadriceps tendon autografts versus HT and comparable survival rates.…”

Section: Discussionmentioning

confidence: 99%

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

Eggeling

Breer

Drenck

et al. 2021

Orthopaedic Journal of Sports Medicine

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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.

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“…However, a follow-up study by the same group evaluated low- and high-volume ACL surgery centers and reported on similar failure rates for both the QT (2.9%) and BPTB (2.3%) for high-volume centers. 23 Widner et al 35 compared large cohorts of QT, BPTB, and hamstring tendon autografts and found no significant differences in failure rates.…”

Section: Discussionmentioning

confidence: 99%

Qualitative and Quantitative Anatomy of the Human Quadriceps Tendon in Young Cadaveric Specimens

Strauss

Kennedy

Brady

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: A detailed understanding of the anatomy of the quadriceps tendon (QT) is clinically relevant, owing to its increased use as a graft in anterior cruciate ligament reconstruction. Purpose: To qualitatively and quantitatively describe the anatomy of the QT in younger adult specimens. Study Design: Descriptive laboratory study. Methods: A total of 18 nonpaired cadaveric knees with a mean age of 30.1 years (range, 18-38 years) were utilized for this study. A 3-dimensional coordinate measuring system was used to assess the structural relationships between the different layers of the QT and their attachments to the patella, and QT thickness was measured medially, centrally, and laterally at 2-cm intervals from the patellar eminence line (PEL; defined as a straight line between the medial and lateral patellar eminences) and proximally. Results: In all specimens, 3 distinct layers formed the QT. The first (superficial) layer was formed by the rectus femoris, which was fused to the second layer with an unclearly defined direct attachment to the patella. The median length of the QT was 86.9 mm (range, 68.4-98.9 mm). The second (middle) layer consisted of the vastus medialis and vastus lateralis and was found to have fibers running in an oblique direction that attached on the patella. A “fuse point,” where the proximal part of the rectus femoris started to merge to the second layer, was identified at a median of 48.7 mm (range, 27.9-62.6 mm) from the PEL. The third (deep) layer consisted of the vastus intermedius. The median thickness of the graft centrally at 20, 40, 60, 80, and 100 mm from the PEL was 8.5, 7.2, 7.5, 6.5, and 5.4 mm, respectively. Conclusion: Overall, 3 different layers of the QT were consistently found in all specimens. The first layer was fused with the second layer, and the direction of the fibers of the second layer or the vastus medialis and vastus lateralis was oblique. The median length of the QT was 86.9 mm, and the thickness of the tendon diminished proximally. Clinical Relevance: This study allows for a better understanding of QT anatomy when harvesting the tendon as a graft for ligamentous reconstruction.

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Low surgical routine increases revision rates after quadriceps tendon autograft for anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Registry

Abstract: Low department routine increases revision rates after quadriceps tendon autograft for anterior cruciate ligament reconstruction -results from the DanishKnee Ligament Reconstruction Registry.

Cited by 40 publications

References 26 publications

Current concepts in graft selection for anterior cruciate ligament reconstruction

Current concepts in graft selection for anterior cruciate ligament reconstruction

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

Qualitative and Quantitative Anatomy of the Human Quadriceps Tendon in Young Cadaveric Specimens

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