Surgeon’s experience, sports participation and a concomitant MCL injury increase the use of patellar and quadriceps tendon grafts in primary ACL reconstruction: a nationwide registry study of 39,964 surgeries

Abstract

Purpose To investigate the influence of surgeon-related factors and clinic routines on autograft choice in primary anterior cruciate ligament reconstruction (ACLR). Methods Data from the Swedish National Knee Ligament Registry (SNKLR), 2008–2019, were used to study autograft choice (hamstring; HT, patellar; PT, or quadriceps tendon; QT) in primary ACLR. Patient/injury characteristics (sex, age at surgery, activity at time of injury and associated injuries) and surgeon-/clinic-related factors (operating volume, caseload and graft type use) were analyzed. Surgeon/clinic volume was divided into tertiles (low-, mid- and high-volume categories). Multivariable logistic regression was performed to assess variables influencing autograft choice in 2015–2019, presented as the odds ratio (OR) with a 95% confidence interval (CI). Results 39,964 primary ACLRs performed by 299 knee surgeons in 91 clinics were included. Most patients received HT (93.7%), followed by PT (4.2%) and QT (2.1%) grafts. Patients were mostly operated on by high-volume (> 28 ACLRs/year) surgeons (68.1%), surgeons with a caseload of ≥ 50 ACLRs (85.1%) and surgeons with the ability to use ≥ two autograft types (85.9%) (all p < 0.001). Most patients underwent ACLR at high-volume (> 55 ACLRs/year) clinics (72.2%) and at clinics capable of using ≥ two autograft types (93.1%) (both p < 0.001). Significantly increased odds of receiving PT/QT autografts were found for ACLR by surgeons with a caseload of ≥ 50 ACLRs (OR 1.41, 95% CI 1.11–1.79), but also for injury during handball (OR 1.31, 95% CI 1.02–1.67), various other pivoting sports (basketball, hockey, rugby and American football) (OR 1.59, 95% CI 1.24–2.03) and a concomitant medial collateral ligament (MCL) injury (OR 4.93, 95% CI 4.18–5.80). In contrast, female sex (OR 0.87, 95% CI 0.77–0.97), injury during floorball (OR 0.71, 95% CI 0.55–0.91) and ACLR by mid-volume relative to high-volume surgeons (OR 0.62, 95% CI 0.53–0.73) had significantly reduced odds of receiving PT/QT autografts. Conclusion An HT autograft was used in the vast majority of cases, but PT/QT autografts were used more frequently by experienced surgeons. Prior research has demonstrated significant differences in autograft characteristics. For this reason, patients might benefit if surgery is performed by more experienced surgeons. Level of evidence Level III.

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

“…While there is an abundance of short‐, mid‐ and long‐term literature comparing BPTB and HT, little is known about postoperative outcomes of QT. Although BPTB autograft has long been the gold standard in ACL–R, QT is gaining in popularity, especially among patients injured in pivoting sports and in those with concomitant medial collateral ligament injuries [7, 108].…”

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

“…Despite the promising results of QT autograft in the literature, one of the largest registry studies to date evaluating ACLR revision rate by autograft type highlighted potential confounding factors that may affect reported outcomes [14]. In particular, associated knee injuries, surgeon experience, and patient selection may all influence which autograft is used and therefore subsequent outcomes [14, 25]. To date, no clear consensus has been reached to suggest a superior autograft option and for which subset of the population [5, 24, 27].…”

Atualização Sobre Reconstrução Do Ligamento Cruzado Anterior Utilizando Enxerto Do Tendão Patelar Ou Tendão Quadríceps: Revisão Sistemática

“…A seleção apropriada do enxerto continua sendo um tópico controverso e é amplamente baseada na experiência e preferência do cirurgião. O uso de autoenxerto tendão patelar (TP) na reconstrução do LCA tem sido aceito como padrão-ouro na última década [4][5][6][7][8] . Entretanto, novas opções têm sido estudadas, como o autoenxerto com tendão do quadríceps (TQ), que é relativamente menos popular, mas está ganhando força.…”

“…Entretanto, novas opções têm sido estudadas, como o autoenxerto com tendão do quadríceps (TQ), que é relativamente menos popular, mas está ganhando força. Estudos recentes revelaram bons resultados funcionais e baixas taxas de falha [7][8][9][10][11][12] .…”