Quadriceps tendon autograft for anterior cruciate ligament reconstruction is associated with high revision rates: results from the Danish Knee Ligament Registry

Abstract

Purpose The quadriceps tendon (QT) has recently gained interest as an anterior cruciate ligament reconstruction (ACLR) autograft. There is a paucity of data from large cohort studies on failures and revision rates after ACLR using the QT graft. The purpose of the present study is to use the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, objective knee stability and subjective clinical outcomes in patients who have undergone ACLR with QT, hamstring tendon (HT), and patellar tendon (PT) as a graft for ACLR. It was hypothesized that QT autografts would result in similar objective knee stability and revision rates as HT and PT autografts. Methods Data on primary ACLRs in the DKRR from 2005 through 2017 were analyzed. Knee injury and Osteoarthritis Outcome Scores (KOOS), Tegner activity scale scores, sagittal knee laxity, pivot‐shift tests at 1‐year follow‐up and revision rates at 2‐year follow‐up were compared for the three autograft cohorts. Results A total of 531 QT, 14,213 HT and 1835 PT ACLR were registered in the DKLR between 2005 and 2017. QT autograft was associated with statistically significant increased laxity (1.8 mm) compared to HT autograft (1.5 mm) (p < 0.001) and more positive pivot shift. There was a significant higher revision rate for QT (4.7%), compared to PT (1.5%) and HT (2.3%) autografts at 2‐year follow‐up (p < 0.002). Conclusion Quadriceps tendon autografts for ACLR was associated with higher revision rates than HT and PT grafts. QT graft was also associated with small increased objective knee laxity and more positive pivot shift than HT and PT grafts. Level of evidence III

Graft Failure, Revision ACLR, and Reoperation Rates After ACLR With Quadriceps Tendon Versus Hamstring Tendon Autografts: A Registry Study With Review of 475 Patients

“…A large registry study that compared QT/QTB, HT, and patellar tendon (PT) grafts in ACLR 25 showed a 4.7% revision rate for QT, which was higher than that in our study, and a 2.3% rate for HT, similar to that found in our study. The investigators compared the rates of revision ACLR at 2 years after surgery in patients registered in the DKRR: 581 patients with QT, 14,312 patients with HT, and 1835 patients with PT.…”

“…38 It has been argued that the in vitro biomechanical and anatomic features of the QT can be disadvantageous because the lack of parallel fibers might lead to graft elongation over time. 25 Slone et al 38 reported that despite variability in morphologic characteristics of the QT, its use is safe, versatile, and reproducible, with consistent length, depth, and width. Our results are in line with this.…”

“…1,36,42 However, studies have questioned the safety of QT grafting after finding a higher risk of revision surgery and decreased objective knee stability after ACLR for QT compared with HT and BPTB. 25,39 This finding calls for further investigation.…”

Anterior Cruciate Ligament Reconstructions With Quadriceps Tendon Autograft Result in Lower Graft Rupture Rates but Similar Patient-Reported Outcomes as Compared With Hamstring Tendon Autograft: A Comparison of 875 Patients

“…By contrast, a recently published Danish registry study, including high-and low-volume orthopaedic departments, found a higher rerupture rate for the QT autograft (4.7%) as compared with the HT autograft (2.3%), whereas the QT revision rate dropped to 1.6% when only highvolume departments were included. 22,23 Lind et al 21 reported in a prospective randomized study no significant difference in rerupture rate between 50 patients treated with QT autografts and 49 patients treated with HT autografts. In the present study, graft choice was a factor significantly influencing the risk of graft rupture, with the odds of rerupture being 2.7 times greater in patients with an HT autograft (4.9%) than a QT autograft (2.8%; Table 5).…”

Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts

“…Notwithstanding, the failure rate in high-risk patients is still to be assessed through registry data and or RCTs to state the superiority of the QT graft. The Danish Registry43 reported a greater failure rate with QT grafts. They showed a 4.9% failure rate for QT, a 2.7% failure rate for HT and a 1.6% failure rate for BPTB.…”