Lower donor-site morbidity using QT autografts for ACL reconstruction

Abstract

Purpose Comparing scar cosmesis and regional hypoesthesia at the incision site between quadriceps tendon (QT), bone–patellar tendon–bone (BPTB), and hamstring tendon (HT) for anterior cruciate ligament (ACL) reconstruction. Methods Ninety patients undergoing ACL reconstruction with QT, HT or BPTB were evaluated at 1‐year post‐op. Scar cosmesis was assessed using the patient and observer scar assessment scale (POSAS) and length of the incision. Sensory outcome was analyzed by calculating the area of hypoesthesia around the scar. The classical ACL reconstruction functional follow‐up was measured using the Lysholm score and KOOS. Results Concerning QT versus BPTB group, QT patients have a significantly lower mean POSAS (24.8 ± 6.3 vs. 39.6 ± 5.8; p < 0.0001), shorter mean incision (2.8 ± 0.4 cm vs. 6.4 ± 1.3 cm; p < 0.0001), lower extent of hypoesthesia (8.7 ± 5.1 cm2 vs. 88.2 ± 57 cm2; p < 0.0001), and better Lysholm score (90.1 ± 10.1 vs. 82.6 ± 13.5; n.s.). No significant difference was seen in KOOS (90.7 ± 7.2 vs. 88.4 ± 7.0; n.s.). Concerning QT versus HT group, no significant difference was found regarding mean POSAS score (24.8 ± 6.3 vs. 31.8 ± 6.2; n.s.), mean length of the incision (2.8 ± 0.4 cm vs. 2.5 ± 0.6 cm; n.s.), KOOS (90.7 ± 7.2 vs. 89.8 ± 8.2; n.s.) and mean Lysholm score (90.1 ± 10.1 vs. 87.8 ± 0.6; n.s.). The mean measured area of hypoesthesia was significantly higher in the HT group (70.3 ± 77.1 cm2 vs. 8.7 ± 5.1 cm2; p < 0.0001). Conclusion Quadriceps tendon harvesting technique has the safest incision by causing less sensory loss compared to BPTB and HT. It also has the advantage of a short incision with more cosmetic scar compared to BPTB, with no difference compared to HT. However, no significant difference in terms of functional outcome was shown between the three autografts. These findings provide surgeons evidence about their clinical practice and help with graft choice decisions. Level of evidence III.

Quadriceps tendon has a lower re-rupture rate than hamstring tendon autograft for anterior cruciate ligament reconstruction – A meta-analysis

“…There were 15 studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] (Level of evidence I: 3; II: 2; LOE III: 10) comparing 611 patients with QT to 543 patients with HS, with a mean follow-up time of 27.4 months. The mean age was 27.9, and 71.1% were male.…”

Long-term Outcomes of Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon–Patellar Bone Autograft

“…Systematic reviews comparing QT/QTPB autografts with other types of autografts suggested that the former type provide comparable clinical and functional outcomes, but with reduced donor-site pain. 2 , 13 , 14 , 18 Other comparative studies also advocated the use of QT/QTPB autografts due to the lower rates of sensory loss, 12 stronger extensor mechanism, 1 and superior biomechanical characteristics. 16 Fu et al 4 reported 5 cases of patella fracture (among 57 patients) after harvesting QTPB autografts proposing a problem specific to the graft; similarly, 6 cases of patella fracture (4 intraoperatively and 2 postoperatively) occurred in the present study.…”

Incidence and Risk Factors for Residual High-Grade Pivot Shift After ACL Reconstruction With or Without a Lateral Extra-articular Tenodesis

“…It was therefore possible to separate the patients into 4 groups: (1) single-strand quadrupled semitendinosus ACLR without LET (ST4 group) (n = 55), (2) ST4 with additional anatomic LET using the same hamstring graft (ST4+LET group) (n = 77) , (3) bone–patellar tendon and LET (BTB+LET group) (n = 43), and (4) quadriceps tendon and LET (QT+LET group) (n = 91). 24…”