Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient-reported outcome measures, but lower donor-site morbidity compared with hamstring tendon autograft: A matched-pairs study with a mean follow-up of 6.5 ​years

Runer, Armin; SUTER, Aline; Sarsina, Tommaso Roberti di; JUCHO, Lena; Gföller, Peter; Csapo, Robert; Hoser, Christian; Fink, Christian

doi:10.1016/j.jisako.2022.08.008

Cited by 23 publications

(15 citation statements)

References 52 publications

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“…The results of this study demonstrated similar post‐ACLR knee stability and functional outcomes (Lysholm, modified Cincinnati, and short‐form‐36 scores) between QT and HT. Runer et al performed a case‐matched study of 45 QT and 45 HT patients with isolated ACLRs [28]. At 6.5 years follow‐up, similar functional outcomes and revisions were found between the two groups.…”

Section: Discussionmentioning

confidence: 97%

Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction

Zhou

Fuimaono-Asafo

Frampton

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo evaluate the functional and graft survivorship outcomes of the three most common autograft options for primary anterior cruciate ligament reconstruction (ACLR)—hamstring tendon (HT), bone‐patella‐tendon‐bone (BPTB), and quadriceps tendon (QT). MethodsPatients captured by the New Zealand ACL registry who underwent a primary ACLR from 2014 to 2020 were considered for the study. Patients with associated knee injury (including meniscus, chondral, osseous, and additional ligamentous injury) and previous knee surgery were excluded. Comparison was made between HT, BPTB, and QT autografts with respect to Marx and KOOS (Knee Osteoarthritis Outcome Score) scores at minimum 2 years follow‐up. In addition, graft survivorship was evaluated by comparing all‐cause revision per 100 graft years and revision‐free proportion at 2 years post‐surgery. Results2,582 patients (1,921 HT, 558 BPTB, 107 QT) were included in the study. Differences in adjusted functional outcomes between HT and BPTB were found at 12 months (mean Marx; HT 6.2; BPTB 7.1; P < 0.001) (mean KOOS Sport and Recreation; HT 75.1; BPTB 70.5; n.s.) and 24 months (mean KOOS Sports and Recreation; HT 79.2; BPTB 73.9; P < 0.001). QT was comparable to HT and BPTB in all functional scores at 12 months and 2 years. No statistically significant differences were found in revision rate between all three autograft groups up to 2 years post‐surgery (revision rate per 100 graft years; HT 1.05; BPTB 0.80; QT 1.68; n.s. HT vs. BPTB; n.s. HT vs. QT; n.s. QT vs. BPTB). ConclusionsQT was found to be comparable to both HT and BPTB in all functional scores and revision rates up to 2 years post‐surgery. Level of evidenceLevel III.

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Section: Discussionmentioning

confidence: 97%

Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction

Zhou

Fuimaono-Asafo

Frampton

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…10 There is less donor site morbidity, improved Lysholm scores, and lower failure rates as well associated with the QT when compared with HT and/or BPTB autograft. 6-8 Therefore, we feel the QT is an adequate graft for young athletes.…”

Section: Video Transcriptmentioning

confidence: 94%

Tips and Tricks for Anatomic ACL Reconstruction With Soft-Tissue Quadriceps Tendon and Remnant Repair

Dadoo,

Keeling,

Runer

et al. 2023

Video Journal of Sports Medicine

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Background: Quadriceps tendon (QT) autograft represents an excellent option for anterior cruciate ligament (ACL) reconstruction (ACLR), with minimal donor site morbidity and failure rates comparable with bone-patellar tendon-bone (BPTB) autograft. This video aims to provide technical tips for ACLR using all-soft-tissue QT autograft. Indications: ACLR with QT autograft is indicated in young, active ACL-injured patients who desire a return to sport. It represents a viable option in both primary and revision ACLR, as well as in skeletally immature patients. It is particularly indicated in those who kneel frequently, such as wrestlers or laborers, due to the lower incidence of postoperative anterior knee pain. Technique Description: A vertical incision is used to harvest a 10 mm × 70 mm partial thickness, all-soft-tissue QT graft. Care is taken not to violate the capsule or musculature. If necessary, graft size is modified based on preoperative magnetic resonance imaging (MRI) measurement of the notch width. The graft is then prepared with continuous loop suspensory fixation on the femoral side and draw sutures on the tibial side. The lateral femoral notch is debrided to allow for visualization of the posterior wall to enable anatomic tunnel placement. When possible, the tibial stump is preserved. The femoral tunnel is drilled via an anteromedial portal and the tibial tunnel via a tibial guide. The graft is then passed through the tibial stump into the femur. It is fixed on the tibial side with a PEEK interference screw in full extension with application of a posterior drawer. Results: Outcomes following ACLR with QT autograft are excellent, with laxity and patient-reported outcomes comparable with those following ACLR with BPTB and hamstring autograft. Furthermore, QT ACLR has been shown to result in less donor site morbidity than BPTB autograft, and lower rates of failure and infection compared with hamstring autograft. Conclusion: ACLR with QT autograft is a good option in young, active patients in both the primary and revision settings. Advantages of QT ACLR include less donor site morbidity than BPTB, and lower rates of failure compared with hamstring autograft in young patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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“…Similarly, no significant differences in PROs were reported in competitive football players [82]. A registry study including 479 patients and two matched-pair analysis further revealed no significant difference between PROs following isolated QT or HT ACL-R in short-and after minimum five years [109][110][111]. Recent smaller observational studies as well as systematic reviews and metanalyses have confirmed the findings of the above-mentioned comparative studies, showing comparable PROs between patients treated with both graft options [2,9,21,86,91,95,99,127].…”

Section: Patient Reported Outcome Measuresmentioning

confidence: 96%

“…Anterior knee and kneeling pain is the most common postoperative complication related to graft choice, reported in up to 21.5% of patients [1]. Evidence suggests that patients treated with BPTB have a significantly higher incidence (up to 72%) of postoperative anterior knee and kneeling pain compared to those treated with HT (up to 44%) or QT (up to 9.3%), possibly attributable to injury of the infrapatellar nerve and/or irritating of the Hoffa fat pad during BPTB harvest [10, 33,41,81,92,104,110,111,118,125]. When comparing HT to QT, no significant differences [2, 92,119,127] or slightly better outcomes were reported for QT [71,110].…”

Section: Complications and Donor Site Morbiditymentioning

confidence: 99%

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications

et al. 2023

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Postoperative patient satisfaction after anterior cruciate ligament reconstruction (ACL-R) is influenced mainly by the degree of pain, the need for reoperation, and functional performance in daily activities and sports. Graft choice has shown to have an influence on postoperative outcomes after ACL-R. While patient reported outcomes measurements do not differ between graft options, evidence shows that normal knee kinematics is not fully restored after ACL-R with an increase in postoperative anterior tibial translation (ATT). Postoperative graft rupture rates seem to favor bone-patella-tendon-bone (BPTB) and quadriceps tendon (QT) autografts over HT or allografts. While return to sports rates seem comparable between different graft types, postoperative extensor strength is reduced in patients with BPTB and QT whereas flexion strength is weakened in patients with HT. Postoperative donor site morbidity is highest in BPTB but comparable between HT and QT. With all graft options having advantages and drawbacks, graft choice must be individualized and chosen in accordance with the patient.

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Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient-reported outcome measures, but lower donor-site morbidity compared with hamstring tendon autograft: A matched-pairs study with a mean follow-up of 6.5 years

Cited by 23 publications

References 52 publications

Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction

Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction

Tips and Tricks for Anatomic ACL Reconstruction With Soft-Tissue Quadriceps Tendon and Remnant Repair

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications

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Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient-reported outcome measures, but lower donor-site morbidity compared with hamstring tendon autograft: A matched-pairs study with a mean follow-up of 6.5 ​years

Cited by 23 publications

References 52 publications

Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction

Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction

Tips and Tricks for Anatomic ACL Reconstruction With Soft-Tissue Quadriceps Tendon and Remnant Repair

Current trends in graft choice for primary anterior cruciate ligament reconstruction – part II: In‐vivo kinematics, patient reported outcomes, re‐rupture rates, strength recovery, return to sports and complications

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Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient-reported outcome measures, but lower donor-site morbidity compared with hamstring tendon autograft: A matched-pairs study with a mean follow-up of 6.5 years