Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

Sheean, Andrew J.; Musahl, Volker; Slone, Harris S.; Xerogeanes, John W.; Milinkovic, Danko Dan; Fink, Christian; Hoser, Christian

doi:10.1136/bjsports-2017-098769

Cited by 87 publications

(80 citation statements)

References 46 publications

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“…There has been increased interest in the quadriceps tendon (QT) as an alternative autologous graft source for ACLR 13. The QT graft has a long track record in ACL revision and posterior cruciate ligament (PCL) reconstruction surgery.…”

Section: Objectivesmentioning

confidence: 99%

Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial

et al. 2019

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ObjectiveWe performed a randomised controlled trial (RCT) in patients undergoing ACL reconstruction (ACLR) using either quadriceps tendon graft (QT) or semitendinosus/gracilis hamstring (STG) graft. We compared subjective outcome (primary outcome) and knee stability, donor site morbidity and function (secondary outcomes).MethodsFrom 2013 to 2015, we included 99 adults with isolated ACL injuries in the RCT. Fifty patients were randomised to QT grafts and 49 to STG grafts and followed for 2 years. Patient evaluated outcomes were performed by subjective International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Kujala and Tegner activity scores. Knee laxity was measured with a KT-1000 arthrometer. Donor site morbidity was evaluated by the ‘donor site-related functional problems following ACLR score’. One-leg hop test tested limp strength symmetry.ResultsAt 2-year follow-up, there was no difference between the two graft groups regarding subjective patient outcome, knee stability and reoperations. Also, at 2 years, donor site symptoms were present in 27% of patients in the QT group and 50% of patients in the STG group. The donor site morbidity score was 14 and 22 for the QT and STG, respectively. Hop test demonstrated lower limp symmetry for QT graft than STG graft of 91% and 97% respectively.ConclusionQT graft for ACLR did not result in inferior subjective outcome compared with STG graft. However, QT graft was associated with lower donor site morbidity than STG grafts but resulted in more quadriceps muscle strength deficiency than hamstring grafts. Both graft types had similar knee stability outcome.Trial registration numberNCT02173483.

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Section: Objectivesmentioning

confidence: 99%

Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial

et al. 2019

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“…5,37,44 The QT provides a thicker graft with favorable tensile properties—namely, a higher load to failure, higher strain at failure, and higher Young modulus of elasticity as compared with BPTB and HT autografts. 10,11,41,43 Furthermore, it may be harvested with or without a femoral bone block. 5 Retrospective and prospective cohort studies have revealed comparable patient-reported outcomes with all 3 grafts.…”

mentioning

confidence: 99%

“…5 Retrospective and prospective cohort studies have revealed comparable patient-reported outcomes with all 3 grafts. 3,10,18,23,28,41,42 Proponents of the QT autograft appreciate that the function of the HT may be preserved, since hamstring muscles act as agonists of the ACL and dynamic medial stabilizers of the knee. 12,13,27 While graft rupture rates of the QT autograft (2.0%-4.8%) are comparable with those of BPTB autografts, 7,9,10,28,31,32,34 little is known about the rates of graft rupture between QT and HT autografts in primary ACL surgery.…”

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confidence: 99%

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

et al. 2020

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Background: Graft rupture is a devastating outcome after anterior cruciate ligament (ACL) reconstruction (ACLR). Little is known about graft rupture rates as well as clinical and functional outcomes after ACLR with quadriceps tendon (QT) autografts. Purpose: To compare QT with hamstring tendon (HT) autografts in terms of the rates of graft and contralateral ACL rupture as well as patient-reported outcome measures. Study Design: Cohort study; Level of evidence, 3. Methods: All primary ACLRs performed between 2010 and 2016 were followed prospectively for 24 months through the recording of graft ruptures and contralateral ACL injuries as well as patient-administered questionnaires. Results: A total of 875 patients were included in the study. Three factors—graft type, age group, and activity level—had a significant value in predicting the need for revision surgery. The odds of revision surgery were 5.5 times greater in children younger than 15 years than in adults older than 45 years, 3.6 times greater in patients with high activity levels than low activity levels, and 2.7 times greater in patients receiving an HT autograft as compared with a QT autograft. A significantly higher rate of ipsilateral graft ruptures versus contralateral ACL injuries was observed in the HT group (4.9% vs 2.3%; odds ratio, 2.1; P = .01) but not in the QT group (2.8% vs 2.3%). The difference in the ratios of graft and contralateral ACL ruptures was even more pronounced in highly active patients treated with HT autografts (11.1% vs 4.2%; odds ratio, 2.6; P = .01) as compared with QT autografts (5.0% vs 2.8%; P = .48). Two-year measures of Lysholm scores (mean ± SD: QT, 86.0 ± 22.3; HT, 89.4 ± 16.4) and Tegner activity scores (QT, 6.1 ± 2.0; HT, 5.7 ± 1.9) as well as visual analog scale pain (QT, 0.8 ± 1.3; HT, 0.7 ± 1.1) did not differ between grafts. Conclusion: Graft choice does not influence clinical and functional outcomes 2 years after ACLR. However, 3 factors—graft type, age group, and activity level—have a significant value in predicting the need for revision surgery. Patients treated with HT autografts have a significantly higher, activity-dependent risk of revision surgery and experience more ipsilateral graft ruptures than subsequent contralateral ACL injuries when compared with patients treated with QT autografts. Young age and high activity level are significant predictors for ACL revision surgery.

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“…The quadriceps tendon is a novel graft choice for ACL reconstruction in adolescent and adult patients. 6,21,22,32-34 The quadriceps tendon, either as an isolated soft tissue graft or with a patellar bone block, has been shown to provide favorable outcomes among adult and adolescent patients. 21,23,32 The quadriceps tendon graft is associated with decreased incidence of postoperative anterior knee pain and better extensor strength recovery as compared with the bone–patellar tendon–bone graft.…”

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confidence: 99%

Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

et al. 2019

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Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

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Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

Cited by 87 publications

References 46 publications

Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial

Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial

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

Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

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