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

Abstract

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.

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

“…37 Moreover, a 2-year randomized controlled trial with 99 patients reported no significant differences in PROMs, in spite of a significantly lower donor site morbidity for the QT tendon. 21 A recently published systematic review and meta-analysis comparing QT autografts with BPTB and HT autografts found no significant difference between patients treated with QT and BPTB autografts in the Lysholm score as well as the subjective and objective International Knee Documentation Committee scores. 28 However, the BPTB cohort had significantly more donor site morbidities than the HT group.…”

“…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).…”

Low surgical routine increases revision rates after quadriceps tendon autograft for anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Registry

“…The 251 present study's findings also suggest that QT graft for ACLR can result in revision rates 252 similar to those of HT and PT grafts when performed routinely. This calls for QT graft 253 usage in ACLR since this graft type in several level-1 studies has also been shown to 254 have the least donor site morbidity [13,15]. 255…”

Open Full-Thickness Quadriceps Tendon Autograft Harvest With Repair for Anterior Cruciate Ligament Reconstruction

“…In addition to superior patient-reported outcomes and decreased rates of graft retear, the quadriceps tendon autograft confers lower complication rates and donor-site morbidity than the hamstring tendon autograft. 36 , 37 A study looking at 1638 revision ACLR cases found the quadriceps autograft group to have significantly lower incidence of postoperative septic arthritis of than the hamstring group (0.16% vs 1.29%, P = .013). 38 A different study reported on donor-site morbidity by evaluating sensory loss and found the mean measured area of hypoesthesia was significantly lower in the quadriceps group compared with the hamstring group (70.3 ± 77.1 cm 2 vs 8.7 ± 5.1 cm 2 ; P < .0001).…”