Quadriceps tendon autograft with or without bone block have comparable clinical outcomes, complications and revision rate for ACL reconstruction: a systematic review

Abstract

Purpose The purpose of this systematic review is to report complications, graft failure, fixation methods, rehabilitation protocol, clinical and patient-reported outcomes, and return to sports with the use of quadriceps tendon graft with the bone block (QT-B) and without bone block (QT-S). Methods According to the PRISMA guidelines a comprehensive search was performed across PubMed/MEDLINE, Scopus, EMBASE, and Cochrane Library databases from inception until April 2022. Only prospective studies using quadriceps tendon autograft with a minimum of 20 patients were considered for inclusion. The outcome measures extracted from the studies were the KT-1000, Lysholm score, Subjective and Objective IKDC, Tegner, Marx Score, complications, failures and/or revision surgery, and rate of return to sports. Cochrane risk of bias and MINORS tool were used for the risk of bias assessment of all included studies. Results A total of 13 studies were included, consisting of 5 randomized controlled trials, 6 cohort studies, 1 case–control and 1 case series. A total of 484 patients received QT-S in 6 studies of which 224 (46.2%) were males and 212 (43.8%) females with a mean age of 21.5 ± 7.5 (range 14–58). While 243 patients received QT-B in 7 studies of which 167 (68.7%) were males and 76 (31.3%) females with a mean age of 28.9 ± 4.5 (range: 18–49). The studies analyzed had a mean MINORS score of 14.6 (range, 12–19). Both QT-B and QT-S for ACL reconstruction reported satisfactory results in terms of patient-reported outcome measures. Although, a slightly higher anterior laxity was found with the QT-S than with the QT-B. Conclusion Quadriceps tendon with a bone block (QT-B) or without bone block (QT-S) for ACL reconstruction is supported by current literature. Both grafts are safe and viable options for ACL reconstruction with comparable clinical outcomes, complications and revision rates. Level of evidence Level IV. Registration PROSPERO-CRD42022347134; https://www.crd.york.ac.uk/prospero/

Novas técnicas de enxertia para reconstrucão do LCA: Artigo de atualização

“…Despite these differences, a recent systematic review compared the use of the QT graft with or without a bone fragment and showed that both grafts are safe and viable, with comparable clinical results, complications and revision rates. 51 Furthermore, QT graft can be used with partial or full thickness, with no difference between them in a recent systematic review. 52 When compared to other graft options, the QT graft has benefits such as lower morbidity at the donor site (defined as anterior knee pain, difficulty or inability to kneel or both) when compared to the patellar tendon autograft.…”

“…Apesar dessas diferenças, uma revisão sistemática recente comparou a utilização do enxerto TQ com ou sem fragmento ósseo e mostrou que ambos os enxertos são seguros e viáveis, com resultados clínicos, complicações e taxa de revisão comparáveis. 51 Além disso, o enxerto TQ pode ser utilizado com espessura parcial ou total, sem diferença entre eles em revisão sistemática recente. 52…”

“…Despite these differences, a recent systematic review compared the use of the QT graft with or without a bone fragment and showed that both grafts are safe and viable, with comparable clinical results, complications and revision rates. 51 Furthermore, QT graft can be used with partial or full thickness, with no difference between them in a recent systematic review. 52…”

Grafts Comparison Between Quadriceps Tendon Autograft vs. Allograft for Anterior Cruciate Ligament Revisioon Reconstruction: A Literature Review

“…In contrast, the deep portion has an avascular area of 10 mm proximal to the border of the patella, measuring approximately 30 mm × 15 mm. [6] Fig. 1 Anatomy of the quadriceps femoris muscle in frontal and sagittal view…”

Primary Versus Revision ACL Reconstruction Using Quadriceps Autograft: A Matched-Control Cohort Study

“…11 Graft choice for the ACL reconstruction influences the clinical outcomes, graft rupture, and complications. 12,21 Therefore, the appropriate choice of graft is an essential part of ACL reconstruction.…”