Patient-Reported Knee Outcome Scores With Soft Tissue Quadriceps Tendon Autograft Are Similar to Bone–Patellar Tendon–Bone Autograft at Minimum 2-Year Follow-up: A Retrospective Single-Center Cohort Study in Primary Anterior Cruciate Ligament Reconstruction Surgery

Abstract

Background: Quadriceps tendon (QT)–bone autografts used during anterior cruciate ligament (ACL) reconstruction have provided comparable outcomes and decreased donor-site morbidity when compared with bone–patellar tendon–bone (BPTB) autografts. No study has directly compared the outcomes of the all–soft tissue QT autograft with that of the BPTB autograft. Hypothesis: Patient-reported knee outcome scores and rates of postoperative complication after primary ACL reconstruction with QT autografts are no different from BPTB autografts at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 75 patients who underwent primary autograft ACL reconstruction with QT or BPTB autografts between January 1, 2015, and March 31, 2016, at a single hospital center were contacted by telephone and asked to complete the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation, Tegner activity level scale, and Lysholm knee scoring scale. Information about the subsequent surgeries performed on the operative knee was also collected. Statistical analysis was performed using the Kruskal-Wallis test and the Fisher exact test for categorical data. Results: Fifty patients (28 QT, 22 BPTB) completed the surveys at a mean follow-up of 33.04 months (range, 24-44 months). For the QT versus the BPTB group respectively, the median IKDC scores were 94.83 (interquartile range [IQR], 7.61) versus 94.83 (IQR, 10.92) ( P = .47), the median Tegner scores were 6 (IQR, 2.5) versus 6 (IQR, 2.75) ( P = .48), and the median Lysholm scores were 95 (IQR, 9) versus 95 (IQR, 13) ( P = .27). Additionally, 2 QT patients and 3 BPTB patients required follow-up arthroscopy for arthrolysis ( P = .64). There was 1 graft failure in the QT group requiring revision surgery. Conclusion: There was no statistical difference in patient-reported knee outcomes or graft complication rates between the QT and BPTB autograft groups at a minimum 2-year follow-up after primary ACL reconstruction. This study highlights that the all–soft tissue QT autograft may be a suitable graft choice for primary ACL reconstruction.

Both low and high knee flexion angles during tibial graft fixation yield comparable outcomes following ACL reconstruction with quadriceps tendon autograft: A systematic review

“…After screening using the inclusion and exclusion criteria explained previously, there were 16 studies that were used for this review (Figure 1). [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] The title and abstract screening had substantial inter-reviewer agreement as the κ score was 0.73 (95% CI, 0.66 -0.80) and there was almost perfect agreement after the full text screening 0.84 (95% CI, 0.72 -0.95). Any studies that cited surgical techniques had the subsequent techniques reviewed for KFA.…”

“…The majority of the L-KFA group patients underwent a form of transtibial drilling of the femoral tunnel (647 patients), [30][31][32][33]35,36,38,40,41,43 with one study using the anteromedial portal technique (28 patients). 34 In the H-KFA group there were two studies using a form of the transtibial technique (123 patients), 42,44 two studies using a form of the anteromedial technique (321 patients), 29,39 and one study using the outside-in method (50 patients). 37 Further details regarding the use of a bone block as well as the anchoring devices used for femoral and/or tibial fixation of the graft can be found in Table 2.…”

“…The details of preoperative and postoperative subjective scores reported across included studies are available in Table 3. Postoperative mean IKDC scores ranged from 67.3 to 94.8, 30,32,34,37,43 and from 70.1 to 86.1 29,42,44 in L-KFA and H-KFA groups, respectively (Figure 3). Postoperative Lysholm scores ranged from 87.0 to 95.6, 30,[33][34][35][36]38,41,43 and from 89.0 to 92.1 37,39,42,44 in L-KFA and H-KFA groups, respectively (Figure 4).…”

“…Postoperative mean IKDC scores ranged from 67.3 to 94.8, 30,32,34,37,43 and from 70.1 to 86.1 29,42,44 in L-KFA and H-KFA groups, respectively (Figure 3). Postoperative Lysholm scores ranged from 87.0 to 95.6, 30,[33][34][35][36]38,41,43 and from 89.0 to 92.1 37,39,42,44 in L-KFA and H-KFA groups, respectively (Figure 4). One study in the L-KFA group reported a mean postoperative Tegner score of 6.0, 34 while three studies in the H-KFA group reported scores ranging from 4.1 to 5.9.…”

Anterior Cruciate Reconstruction with Quadriceps Autograft using QuadLink Anterior Cruciate Ligament FiberTag TightRope Implant

“…When a quadriceps tendon harvest is performed, there is a risk of violating the suprapatellar pouch; however, it should be noted that a disruption of the suprapatellar pouch can be reapproximated using Vicryl suture. 16 Furthermore, the use of suspensory fixation does not allow for bone-to-bone healing present in bone tendon bone ACLR. It should be noted, however, that although bone-to-bone healing is not possible, suspensory fixation has shown excellent fixation strength.…”