Strength recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players: A randomized controlled trial

Martin-Alguacil, Jose Luis; Arroyo-Morales, Manuel; Martín-Gomez, Jose Luis; Monje-Cabrera, Isidro Manuel; Abellán-Guillén, Juan F.; Esparza-Ros, Francisco; Lozano‐Lozano, Mario; Cantarero‐Villanueva, Irene

doi:10.1016/j.knee.2018.03.011

Cited by 56 publications

(114 citation statements)

References 48 publications

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“…Only one study 23 used a minimally invasive technique for graft removal with a suprapatellar transverse incision, while the others used a longitudinal route in the topography of the QT. Most studies used bone plug, except for Martin-Alguacil et al 26 Removal of Hamstring Graft. Two studies did not describe the HT graft removal method.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Preparation of the tunnels and graft fixation. To create the femoral tunnel, two studies 21,22 used the transtibial technique, three studies 23,25,26 opted for the anteromedial portal at the anatomical point, and one of these 24 applied the outside in technique. The creation of the tibial tunnel, which was similar between groups, was performed at the native site of the ACL, medial to the lateral meniscus root and lateral to the medial tibial spine.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Only one study did not use a bone plug. 26 In addition, only one of the studies evaluated did not use the same surgical technique as the control group, 22 since single-bundle ACLR was performed in the QT group and double-bundle ACLR in the HT group. Graft fixation is described in Table 2.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Three studies 23,24,26 evaluated the presence of graft failure in the follow-up performed. None of the studies found a significant difference in the re-rupture rate between groups, yet Martin-Alguacil et al 26 discovered an increased tendency for re-rupture in the HT group (X 2 = 3.31, p=0.10). The re-rupture rate ranged from 0% to 12% in the HT group and from 0% to 3.8% in the QT group (Table 3).…”

Section: Surgical Techniquementioning

confidence: 99%

“…It is possible to find similar clinical outcome and rate of complications between the two groups, with the advantage of lower donor site morbidity in the QT group. [16][17][18][19][20] Regarding studies comparing HT and QT, data in the literature are scarce, [21][22][23][24][25][26] particularly on comparative studies. The aim of this study is to perform a literature review comparing the clinical outcomes of patients undergoing anterior cruciate ligament reconstruction with QT versus HT.…”

Section: Introductionmentioning

confidence: 99%

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Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Salas

Oliveira

Lima

et al. 2020

Rev Bras Med Esporte

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Introduction: Anterior cruciate ligament injury is one of the most prevalent musculoskeletal injuries. Therefore, several surgical techniques and graft types have been described for its reconstruction. Autologous hamstring tendon graft is one of the most frequently used, but use of the quadriceps tendon graft has gained prominence in recent years. Objective: To review the literature to compare the outcomes of patients undergoing anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft versus hamstring tendon (HT) autograft. Methods: A literature review was conducted through PubMed to locate studies (Level of evidence I-III) comparing the outcomes of the QT autograft vs. the HT autograft in patients undergoing primary ACL reconstruction. Patients were assessed on the basis of re-rupture rate, ligament instability, patient-reported outcome scores, previous pain, and isokinetic tests. Results: Six studies were selected according to inclusion criteria. A total of 481 patients were evaluated, 243 in the QT group and 238 in the HT group. The total re-rupture rate was 1.6% (8 of 481), with 6 in the HT group and 2 in the QT group, but with no statistical difference between groups. One study found increased ligament instability in the HT group and another study found greater instability in the QT group, both with statistical significance. Regarding the patient-reported functional scores, only 01 study found statistical difference, with better results in the QT group. There was no difference in previous pain between groups in the selected studies. Regarding the isokinetic test, one study found a difference in flexor force in the HT group (p <0.01), with no difference in extensor force, while another two studies found an increased extensor force deficit in the QT group within up to 01 year of follow-up. The flexor/ extensor muscle strength ratio was higher in the QT group in both studies. Conclusion: ACL reconstruction with QT graft presents re-rupture rates, ligament instability, functional scores and donor site morbidity that are similar to the HT graft, in addition to preserving greater flexor force in proportion to extensor force. Level of evidence: IV; Review study.

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Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Salas

Oliveira

Lima

et al. 2020

Rev Bras Med Esporte

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How statistically fragile are randomized controlled trials comparing quadriceps tendon autografts with hamstring or bone‐patellar tendon‐bone autografts in anterior cruciate ligament reconstruction?

Dworsky‐Fried,

Bernardini,

Vivekanantha

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo determine the statistical fragility of randomized controlled trials (RCTs) which compare the use of quadriceps tendon (QT) autografts to either hamstring tendon (HT) or bone‐patellar tendon‐bone (BPTB) autografts in anterior cruciate ligament reconstruction (ACLR).MethodsA search was conducted across PubMed, MEDLINE and EMBASE databases for RCTs comparing QT autografts to HT or BPTB autografts in ACLR from inception to 21 April 2024. Studies that reported ≥1 statistically significant continuous outcome, statistically significant dichotomous outcome and/or nonsignificant dichotomous outcome were included for analysis. The fragility index (FI), continuous fragility index (CFI) and reverse fragility index (RFI) were calculated for significant dichotomous outcomes, significant continuous outcomes and nonsignificant dichotomous outcomes, respectively.ResultsA total of 11 RCTs comprising 716 patients were included. The mean sample size was 65.8 patients. The median FI among nine outcomes from four studies was 1.0 (interquartile range [IQR], 0.5; 95% confidence interval [CI], 0.6–1.4; range 0.5–1.5). The number of patients lost to follow‐up at the final follow‐up period was more than the study‐specific FI in three (75%) studies. The median CFI among 30 outcomes from six studies was 4.9 (IQR, 10.1, 95% CI, 3.9–8.2; range 0–18.2). The number of patients lost to follow‐up at the final follow‐up period was more than the study‐specific CFI in four (66.7%) studies. The median RFI among 10 outcomes from five studies was 5.0 (IQR, 3.5; 95% CI, 3.4–6.6; range 1.0–9.0). The number of patients lost to follow‐up at the final follow‐up period was more than the study‐specific RFI in four (80%) studies.ConclusionThis systematic review revealed that regardless of the metric used, RCTs comparing QT autografts to HT or BPTB autograft options in ACLR are statistically fragile. While the indices of statistical fragility evaluated in this study are important metrics of robustness to consider, their application in research and clinical practice needs to be further elucidated.Level of EvidenceLevel I.

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Demographic and surgical factors affect quadriceps strength after ACL reconstruction

Kuenze

Pietrosimone

Lisee

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate the effects of graft source, time since surgery, age, and sex on unilateral and symmetry‐based measures of knee extension strength among individuals with ACL reconstruction (ACLR). Methods Three hundred and eight individuals aged 13–40 years old with primary, unilateral ACLR in the last 60 months were enrolled in this multi‐site clinical measurement study. Participants completed bilateral knee extension maximal voluntary isometric contraction (MVIC) torque assessments which were normalized to body mass (Nm/kg) and limb symmetry indices (LSI) were calculated. The effects of graft source (patellar tendon autograft; hamstring tendon autograft), time since surgery (≤ 12 months; >12 mo.), age (≤ 18 years; >18 years), and sex were evaluated using separate ANCOVAs. Results A significant interaction was present between time since surgery and graft source for LSI (P = 0.01) as participants with patellar tendon autografts ≤ 12 months post‐ACLR experienced the greatest asymmetry (LSI = 69.2 ± 24.5%). Significant interactions were present between time since surgery and sex for involved limb (P = 0.01) and uninvolved limb MVIC torque (P = 0.05) with females ≤ 12 months post‐ACLR being weakest (involved MVIC = 1.81 ± 0.70 N m/kg; uninvolved MVIC = 2.40 ± 0.68 N m/kg). Participants ≤ 18‐year‐old displayed weaker involved limb (P < 0.001) and contralateral limb (P < 0.001) MVIC torque as compared to participants > 18‐year‐old during the first year after ACLR. Conclusions Graft source, sex, age, and time since surgery effect quadriceps strength and symmetry after ACLR. Surgical and demographic factors should be considered when developing treatment approaches to optimize quadriceps function prior to re‐integration into pre‐injury levels of physical activity. Level of evidence IV.

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Strength recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players: A randomized controlled trial

Cited by 56 publications

References 48 publications

Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

How statistically fragile are randomized controlled trials comparing quadriceps tendon autografts with hamstring or bone‐patellar tendon‐bone autografts in anterior cruciate ligament reconstruction?

Demographic and surgical factors affect quadriceps strength after ACL reconstruction

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