Clinical outcomes after ACL reconstruction with free quadriceps tendon autograft versus hamstring tendons autograft. A retrospective study with a minimal follow-up two years

Abstract

Objective The aim of this retrospective study was to compare the clinical outcomes of anatomic single bundle ACL reconstruction using either a free quadriceps tendon autograft or a quadrupled hamstring autograft with a minimum follow-up of 24 months. Methods Consecutive patients undergoing ACL reconstruction using either a free quadriceps tendon autograft or hamstring tendon autograft from January 2013 to December 2014 were included. ACL reconstruction was done in all patients due to isolated ACL tears. Patients with associated cartilage lesions > Outerbridge III, meniscal lesions in need of meniscectomy or repair as well as patients with prior knee surgery on the affected or contralateral knee were excluded. The primary outcome evaluation was the side-to-side difference in instrumented Lachman testing. Secondary outcome evaluation consisted in the Lysholm, modified Cincinnati and SF-36 scores. Side-to-side difference in range of motion and thigh diameter was also documented. Results After applying the inclusion/exclusion criteria, a total of 82 patients were identified and 72 (87.8%) presented to the hospital for follow-up. There were 39 patients with quadriceps graft (30.64 ± 8.71, range: 18–53 years) and 33 patients with hamstrings (28.60 ± 6.74, range: 18–46 years). No statistically significant difference between groups was detected with regard to KT-1000 measurements (p = 0.326). No significant difference was found between the mean postoperative Lysholm (p = 0.299), the modified Cincinnati (p = 0.665) and the general SF-36 scores between groups (p = 0.588). Less side-to-side thigh diameter difference was noted in the quadriceps graft group (p = 0.026). Conclusion In conclusion, similar clinical results, in terms of stability and subjective measures, can be obtained after ACL reconstruction both with a free quadriceps and a 4-strand hamstring tendons autograft. Level of evidence Level III, Therapeutic Study.

Lesiones de ligamento cruzado anterior tratadas con autoinjerto de tendón de cuádriceps versus autoinjerto de isquiotibiales: estudio controlado aleatorizado

“…Another cohort study that compared the use of QT autograft versus HT autograft in a retrospective review of 48 patients with a minimum follow-up of 2 years reported significantly improved manual laxity test results in both groups after surgery; the IKDC score and Tegner activity score were better and not significantly different between the groups, the anatomical ACL reconstruction with QT showed knee stability and functional outcome scores similar to those of HT autografts, but the patients with QT autograft showed better flexor muscle strength recovery 19 . In another retrospective study of 72 patients with a follow-up of 24 months, similar clinical results both autografts were found 20 . In our study, in the evaluation of the Lysholm score and IKDC Subjective Knee Evaluation Form results, all patients showed better results during the follow-up and at the end of the evaluation, with no significant differences between groups.…”

“…There were some limitations in our study, including the reduced sample size and relatively short follow-up. One of the strengths of our study is that unlike previous studies on this topic that used a retrospective cohort study design [18][19][20] , this was a randomized controlled clinical trial. In terms of the level of clinical evidence, the preferred design for a clinical trial is often a randomized controlled trial; prospective and retrospective cohort studies are ranked lower because of the biases inherent to their design.…”

Clinical Outcomes of Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autograft Versus Hamstring Tendons Autograft: A Retrospective Analysis

“…To our knowledge, just one study, done in Romania, by Todor et al (2019), compared the clinical outcomes of these two distinct autografts [ 13 ]. Todor et al study's primary findings indicated that comparable results in terms of stability and patient-reported outcomes could be reached using either a HAM or a free QUADRI autograft [ 13 ]. They revealed no statistically significant differences between groups in terms of instrumented laxity tests, Lysholm scores, and modified Cincinnati scores.…”

Peer Review #1 of "Cross-cultural adaptation and validation of the Romanian International Knee Documentation Committee—subjective knee form (v0.2)"

“…It is the main stabilizer against anterior tibial translation, with functional importance in sports. The aforementioned outcome measures apply also in cruciate ligament reconstruction [2,3,17]. We deliberately excluded ACL surgeries to maintain group homogeneity and target the non-acute pain, meniscus and early degeneration subpopulation.…”