Quadricep ACL Reconstruction Techniques and Outcomes: an Updated Scoping Review of the Quadricep Tendon

Cohen, Dan; Slawaska-Eng, David; Almasri, Mahmoud; Sheean, Andrew J.; de, Darren

doi:10.1007/s12178-021-09726-3

Cited by 11 publications

(6 citation statements)

References 58 publications

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“… 10 , 32 , 37 , 38 Although there remains a paucity of literature reporting on pooled RCT data for complication rates observed with QT versus BPTB autografts, more recent reviews suggest that QT grafts are associated with a lower incidence of donor site morbidity and anterior knee pain postoperatively. 32 , 39 , 40 These reduced rates of anterior knee pain support the hypothesis that QT autograft may be a more appropriate option for patients who have occupations requiring them to squat and kneel repetitively (e.g., carpenters, painters, plumbers) or patients who pray on their knees daily. 5 , 41 It is important to note that the anterior knee pain experienced by patients following ACLR with BPTB is rarely debilitating and that this increased risk should not be the sole determinant of graft choice in most patient populations.…”

Section: Discussionmentioning

confidence: 68%

Following Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Autograft, the Incidence of Anterior Knee Pain Ranges From 5.4% to 48.4% and the Incidence of Kneeling Pain Ranges From 4.0% to 75.6%: A Systematic Review of Level I Studies

Peebles,

Akamefula,

Aman

et al. 2024

Arthroscopy, Sports Medicine, and Rehabilitation

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Section: Discussionmentioning

confidence: 68%

Following Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Autograft, the Incidence of Anterior Knee Pain Ranges From 5.4% to 48.4% and the Incidence of Kneeling Pain Ranges From 4.0% to 75.6%: A Systematic Review of Level I Studies

Peebles,

Akamefula,

Aman

et al. 2024

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Revision cases in this review primarily used BPTB (59.6%) and HT autografts (32.4%), with QT autograft use being uncommon (7.7%). Prior reviews have also found that QT autografts were used much less frequently than BPTB or HT autografts in paediatric primary ACLRs [37]. While certain disadvantages of QT autografts have been cited, including prolonged postoperative quadriceps weakness, donor site pain, and fluid extravasation after arthroscopy, there lacks any concrete evidence against its use in paediatric or adolescent r-ACLR [38].…”

Section: Discussionmentioning

confidence: 99%

“…As such, the low usage rate of QT autografts may reflect an underlying historical bias which favours more traditional choices such as BPTB and HT autografts. Furthermore, initial usages of QT autografts resulted in increased postoperative knee laxity and extensor mechanism weakness, which further increased hesitancy towards its use [37]. Research on QT autograft use for primary ACLR has been gaining popularity in recent years, especially with studies consistently demonstrating decreased failure rates when compared to the HT autografts [42][43][44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review

Sun,

Vivekanantha,

Khalik

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo summarise the surgical techniques and clinical outcomes in paediatric and adolescent patients undergoing revision anterior cruciate ligament reconstruction (r‐ACLR).MethodsThree databases (MEDLINE, PubMed and EMBASE) were searched from inception to 29 July 2023. The authors adhered to the PRISMA and R‐AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details, patient‐reported outcome measures (PROMs), rates of instability, rupture and return to sport (RTS) were extracted.ResultsEight studies comprising 706 (711 knees) patients were included (48.7% female). The mean age at r‐ACLR was 17.1 years (range: 16.5–18.0). Autografts (67.5%) were more common than allografts (32.2%) in revision, with bone‐patellar tendon‐bone (BPTB) being the most prevalent autograft source (59.6%). Bone grafts were used in seven patients (4.8% of 146 patients). The most common femoral and tibial fixation techniques were interference screws (37.6% and 38.1%, of 244 patients, respectively). The most common tunnelling strategy was anatomic (69.1% of 236 patients), and meniscus repairs were performed in 39.7% of 256 patients. The re‐rupture rate was 13.0% in 293 patients. RTS at the same level or higher was 51.6% in 219 patients. The mean (SD) Lysholm score was 88.1 (12.9) in 78 patients, the mean (SD) Tegner score was 6.0 (1.6) in 78 patients, and the mean (SD) IKDC score was 82.6 (16.0) in 126 patients.ConclusionR‐ACLR in paediatric and adolescent patients predominantly uses BPTB autografts and interference screw femoral and tibial fixation with concomitant meniscal procedures. Rates of re‐rupture and RTS at the same level or higher were 13.0% and 51.6%, respectively. Information from this review can provide orthopaedic surgeons with a comprehensive understanding of the most commonly used operative techniques and their outcomes for revision ACLR in this population.Level of Evidence: Level IV.

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“…5,14 Partial-thickness QT (PT-Q) 7,9,27,37 and full-thickness QT (FT-Q) 1,15 graft harvest techniques have been described for ACLR with QT grafts. Although both graft harvest depths are viable options, in 2021, Cohen et al 3 conducted a comprehensive review of QT graft harvest (including 96 studies within the last 5 years) and reported the graft harvest incidence to be 75% for PT-Q grafts and 25% for FT-Q grafts, with grafts ranging from 5 to 8 mm in depth and 8 to 12 mm in width. Irrespective of the difference in graft harvest dimensions, patients undergoing ACLR using QT grafts have shown excellent outcomes.…”

mentioning

confidence: 99%

“…They reported no significant differences in clinical outcomes or complications between the 2 grafts in primary ACLR. They concluded that “primary ACLR using QT autografts appears to have successful outcomes with a low rate of graft failure, irrespective of tendon thickness.” Despite the surgical feasibility of either graft depth, there appears to be a preference toward PT-Q grafts 3 ; however, no standard exists to guide surgeons on graft harvest dimensions, and there appears to be a deficiency in the literature beyond subjective outcomes.…”

mentioning

confidence: 99%

The Associations Between Quadriceps Tendon Graft Thickness and Isokinetic Performance

et al. 2023

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Background: Anterior cruciate ligament reconstruction (ACLR) using the quadriceps tendon is an increasingly popular technique. Both partial-thickness quadriceps tendon (PT-Q) and full-thickness quadriceps tendon (FT-Q) graft depths are employed. Hypothesis/Purpose: This study was designed to assess isokinetic peak torque, average power, and total work during knee extension in patients with FT-Q or PT-Q grafts for ACLR. We hypothesized that both groups would show lower isokinetic values for the operated side, with greater deficits in the FT-Q group than in the PT-Q group. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 26 patients who underwent ACLR with either an FT-Q or PT-Q graft were recruited between June 2021 and November 2021. Patients underwent isokinetic knee extension testing at > 1 year after surgery. Mixed repeated-measures analysis of covariance with least square difference post hoc testing was used to determine significant differences or interactions for all variables. Results: Peak torque was significantly lower for the operated limb than the nonoperated limb in the FT-Q group (mean difference [MD] ± standard error [SE], −38.6 ± 8.3 Nċm [95% CI, −55.7 to −21.5 Nċm]; P < .001; d = 0.90) but not in the PT-Q group (MD ± SE, −7.3 ± 7.7 Nċm [95% CI, −23.2 to 8.5 Nċm]; P = .348; d = 0.20). Similarly, average power for the operated limb was lower than that for the nonoperated limb in the FT-Q group (MD ± SE, −53.6 ± 13.4 W [95% CI, −81.3 to −26.9 W]; P < .001; d = 0.88) but not in the PT-Q group (MD ± SE, –4.1 ± 12.4 W [95% CI, −29.8 to 21.5 W]; P = .742; d = 0.07), and total work was lower for the operated limb compared with the nonoperated limb in the FT-Q group (MD ± SE, −118.2 ± 27.1 J [95% CI, −174.3 to −62.2 J]; P < .001; d = 0.96) but not in the PT-Q group (MD ± SE, −18.3 ± 25.1 J [95% CI, −70.2 to 33.6 J]; P = .472; d = 0.15). Conclusion: The FT-Q group showed significant deficits in the operated limb compared with the nonoperated limb for all isokinetic variables. In contrast, no significant differences were found between the nonoperated and operated limbs for the PT-Q group.

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Quadricep ACL Reconstruction Techniques and Outcomes: an Updated Scoping Review of the Quadricep Tendon

Cited by 11 publications

References 58 publications

Following Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Autograft, the Incidence of Anterior Knee Pain Ranges From 5.4% to 48.4% and the Incidence of Kneeling Pain Ranges From 4.0% to 75.6%: A Systematic Review of Level I Studies

Following Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Autograft, the Incidence of Anterior Knee Pain Ranges From 5.4% to 48.4% and the Incidence of Kneeling Pain Ranges From 4.0% to 75.6%: A Systematic Review of Level I Studies

Approximately half of pediatric or adolescent patients undergoing revision anterior cruciate ligament reconstruction return to the same level of sport or higher: A systematic review

The Associations Between Quadriceps Tendon Graft Thickness and Isokinetic Performance

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