Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Outcomes for Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring-Tendon Autografts

Abstract

Background: Comprehensive studies evaluating quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction are lacking. The optimal choice of graft between bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and QT is still debatable. Hypothesis: The current literature supports the use of QT as a strong autograft with good outcomes when used in ACL reconstruction. Study Design: Meta-analysis; Level of evidence, 2. Methods: A systematic search of the literature was performed in PubMed, MEDLINE, Cochrane, and Ovid databases to identify published articles on clinical studies relevant to ACL reconstruction with QT autograft and studies comparing QT autograft versus BPTB and HT autografts. The results of the eligible studies were analyzed in terms of instrumented laxity measurements, Lachman test, pivot-shift test, Lysholm score, objective and subjective International Knee Documentation committee (IKDC) scores, donor-site pain, and graft failure. Results: Twenty-seven clinical studies including 2856 patients with ACL reconstruction met the inclusion criteria. Comparison of 581 QT versus 514 BPTB autografts showed no significant differences in terms of instrumented mean side-to-side difference ( P = .45), Lachman test ( P = .76), pivot-shift test grade 0 ( P = .23), pivot-shift test grade 0 or 1 ( P = .85), mean Lysholm score ( P = .1), mean subjective IKDC score ( P = .36), or graft failure ( P = .50). However, outcomes in favor of QT were found in terms of less donor-site pain (risk ratio for QT vs BPTB groups, 0.25; 95% CI, 0.18-0.36; P < .00001). Comparison of 181 QT versus 176 HT autografts showed no significant differences in terms of instrumented mean side-to-side difference ( P = .75), Lachman test ( P = .41), pivot-shift test grade 0 ( P = .53), Lysholm score less than 84 ( P = .53), mean subjective IKDC score ( P = .13), donor-site pain ( P = .40), or graft failure ( P = .46). However, outcomes in favor of QT were found in terms of mean Lysholm score (mean difference between QT and HT groups, 3.81; 95% CI, 0.45-7.17; P = .03). Conclusion: QT autograft had comparable clinical and functional outcomes and graft survival rate compared with BPTB and HT autografts. However, QT autograft showed significantly less harvest site pain compared with BPTB autograft and better functional outcome scores compared with HT autograft.

Systematic Review of Publications Regarding Quadriceps Tendon Autograft Use in Anterior Cruciate Ligament Reconstruction

“…18 Multiple recently published systematic reviews have supported the use of the QT as a viable alternative graft option based on clinical and functional outcomes after ACL reconstruction. 6,19,20 Several recent studies have directly compared the clinical outcomes of QT grafts versus quadrupled hamstring grafts, showing equivalent or superior functional outcomes and less postoperative donor-site pain with QT grafts. 19,21,22 This systematic review shows that since the introduction of the QT autograft by Marshall et al 4 in 1979, research regarding its use has been increasing steadily.…”

“…6,19,20 Several recent studies have directly compared the clinical outcomes of QT grafts versus quadrupled hamstring grafts, showing equivalent or superior functional outcomes and less postoperative donor-site pain with QT grafts. 19,21,22 This systematic review shows that since the introduction of the QT autograft by Marshall et al 4 in 1979, research regarding its use has been increasing steadily. This increase in research reflects the growth in popularity as an alternative choice for autograft tissue in ACL reconstruction.…”

Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years

“…The authors are aware of few isolated cases of patients with a quadriceps tendon rupture or a patella fracture after the harvest of the QTB autograft. Some patients also report pain at the donor site [18,19]. In a recent meta-analysis, Riaz et al reviewed five studies comparing results of ACL reconstruction with BPTB and QTB autografts that included a total of 806 patients [20].…”

Current evidence around patellar tendon graft in ACLR for high-risk patients: current concepts

“…Mouarbes et al 42 recently published a meta-analysis, concluding that “QT autograft had comparable clinical and functional outcomes and graft survival rate compared with BPTB and HT autografts. However, QT autograft showed significantly less harvest site pain compared with BPTB autograft and better functional outcome scores compared with HT autograft”.…”