Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months

Abstract

IntroductionAlthough known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24–36 months after primary anterior cruciate ligament (ACL) reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins.Materials and methodsThe study population included 55 patients, of whom 24 were female (43.6%). The mean age at the index procedure was 31.7 years (15–58 years). All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3–38.5 months) after the index procedure. The International Knee Documentation Committee (IKDC) subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee.ResultsGraft harvesting was possible in all cases; a bony extension was never required. On average, graft length was measured at 8.8 cm (7.5–10 cm). The mean IKDC subjective score at follow-up was 80.44 points (55.17–100 points, standard deviation [SD] 12.05). The mean preinjury Tegner activity index was 4.98 (2–7) compared to a mean value of 4.16 (2–7, SD 0.8) at follow-up. There was a mean loss of 0.82 index points. The average Lysholm and Gillquist score was 89 points (65–100, SD 17.7). Of the results, 89.1% were in the good or very good groups; in one case (1.8%), the result was poor, while the rest were fair.ConclusionACL reconstruction using a bone plug-free quadriceps tendon autograft achieved satisfactory results in a midterm review.

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction

“…8 To completely avoid possible patellar fracture and reduce morbidity at the harvest site, a free bone plug graft is the solution. We present our preferred method of free quadriceps graft harvest for ACL reconstruction and describe how we use a suspensory fixation device for femoral fixation with this type of graft.…”

Aperture and Suspensory Fixation Equally Efficacious for Quadriceps Tendon Graft Fixation in Primary ACL Reconstruction: A Systematic Review

“…2). [38][39][40][41][42] There was substantial agreement between reviewers at the title screening stage (κ ¼ 0.72) and almost-perfect agreement at the abstract (κ ¼ 0.81) and full-text (κ ¼ 0.91) screening stages.…”

The Military ACL

“…48,[54][55][56][57][58] Consequently, an increasing interest in quadriceps tendon autografts has emerged due to similar failure rates, patient reported outcome measures, postoperative quadriceps strength, and stability measurements without associated anterior knee pathology or donor site morbidity. [59][60][61][62] Furthermore, the quadriceps tendon structure at second look arthroscopy has been shown to more closely resemble the collagen structure of the native ACL than patellar tendon autografts. 59…”