Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Abstract

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.

A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts

“…Comparing the isokinetic strength test between QTAs and HTAs or PTA, our results were similar to previous systematic reviews [ 36 , 51 , 52 ]. Additionally, our results were similar to a previous meta-analysis by Johnston et al [ 36 ], where QTAs showed better isokinetic strength results during the short-term evaluation and similar results during the long-term evaluation.…”

“…The main purpose of this systematic review and meta-analysis was to compare isokinetic strength tests, functional outcomes, and knee stability between QTAs and HTAs or PTAs after ACL reconstruction. Furthermore, this systematic review and meta-analysis added further quantitative analysis to previous systematic reviews [ 51 , 52 ] and included more studies than previously published studies [ 51 , 52 ]. Overall, 754 patients were evaluated from ten studies, and five of ten studies were included in the meta-analysis.…”

Knee muscle strength after quadriceps tendon autograft anterior cruciate ligament reconstruction: systematic review and meta-analysis

“…The most important finding of this study was early (5-8 months) post-QT ACL reconstruction knee extensor muscle strength was not signiicantly diferent compared to PT but reduced compared to HT and beyond 8 months post-operatively knee extensor strength was comparable between QT ACL reconstruction and alternative ACL grafts. This review adds to our knowledge regarding knee extensor strength following QT ACL reconstruction, as two previous reviews had been unable to make conclusions due to insuicient data [23,46]. Similar knee extensor strength outcomes between QT and the popular PT graft type is encouraging for those surgeons increasingly using QT.…”

“…However, little is known with respect to strength outcomes following QT ACL reconstruction. Only two previous published systematic reviews included knee strength outcomes following QT ACL reconstruction compared to either HT or PT grafts [23, 46]. However, both reviews had insufficient studies to draw conclusions about knee strength outcomes following QT compared to PT ACL reconstruction [23, 46].…”

“…However, both reviews had insuicient studies to draw conclusions about knee strength outcomes following QT compared to PT ACL reconstruction [23,46]. In addition, the results of included studies comparing QT to HT ACL reconstruction are inconsistent, inding either no diference or greater lexor force in QT grafts [23,46].…”