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

Aslam, Mohd Ammar; Avasthi, Sachin; Aggarwal, Pankaj; Singh, Satyam; Kumar, Vineet; Mahapatra, Swagat

doi:10.7759/cureus.18760

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…However, in most cases, allograft ACL reconstruction with non-irradiated grafts is as safe but more expensive than autograft ACL reconstruction, which is preferred as it is more cost-effective. [20,21] Rehabilitation After Quadriceps Tendon Autograft Vs. Allograft In ACL Reconstruction…”

Section: Discussionmentioning

confidence: 99%

Grafts Comparison Between Quadriceps Tendon Autograft vs. Allograft for Anterior Cruciate Ligament Revisioon Reconstruction: A Literature Review

Halim Hasibuan,

Yudhadibrata

2024

JARMHS

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Introduction: Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopaedic surgeries performed on active people in the world. One of the most important surgical decisions is graft type for use in the reconstruction. Recently, the quadriceps tendon has gained popularity for use as a graft source for ACL reconstruction. The graft choice is broadly between an autograft or allograft. This review aims to understand the current concepts in graft comparison between quadriceps tendon autograft vs. allograft for anterior cruciate ligament revision reconstruction. Methods: This literature review study was reported following the preferred reporting items for systematic reviews and adhered to a structured review protocol. The author searched the PubMed, ScienceDirect, and British Medical Journal databases. The authors comparing selected publications reporting patient outcomes with all types of reviews or descriptions of ACL revision reconstruction and its graft being used or other related subjects. Published in English is included. The author then formulates a synthesis to support the previously determined research objectives. Results: ACL reconstruction with partial thickness soft tissue quadriceps tendon graft is a reliable option. Where there are differences in the failure rates of ACL reconstructions between allografts and autografts, these can mostly be explained by irradiated grafts. Giving sufficient radiation to achieve sterility will likely weaken grafts and make them more likely to fail; therefore, irradiating grafts is not recommended. The evidence shows no significant differences in clinical effectiveness between autografts and non-irradiated allografts. Failure rates with both grafts are now low. Discussion: The primary goals of rehabilitation after ACL reconstruction do not vary considerably based on graft type and emphasize: (1) restoration of the full range of motion, (2) normalization of quadriceps strength, (3) improvement of overall lower extremity muscle strength, and (4) re-training of movement patterns to return to pre-injury sports participation while decreasing injury risk. Achieving full motion and quadriceps strength contributes to a rapid return to normal weight bearing, gait, and activities of daily living. In the setting of revision ACL reconstruction, there are various considerations regarding graft choice due to tunnel size or position, previous usage of other grafts, and reconstructions in the other leg, which may mean that allografts would be preferred to autografts. The other population not covered sufficiently in the literature is the elite sprinting athlete, where autograft choices may be influenced by the effect of graft harvesting on their sport. However, in most cases, allograft ACL reconstruction with non-irradiated grafts is as safe but more expensive than autograft ACL reconstruction, which is preferred as it is more cost-effective. Conclusion: There is little difference in the results of ACL reconstruction with autografts or non-irradiated allografts, with any advantage being with autografts. The cost is higher with allografts. So if autografts are available, allografts are not cost-effective.

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Section: Discussionmentioning

confidence: 99%

Grafts Comparison Between Quadriceps Tendon Autograft vs. Allograft for Anterior Cruciate Ligament Revisioon Reconstruction: A Literature Review

Halim Hasibuan,

Yudhadibrata

2024

JARMHS

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“…At 6.5 years follow‐up, similar functional outcomes and revisions were found between the two groups. Several more studies with small sample sizes have also evaluated isolated ACLR outcomes using QT – all of which demonstrated comparability of QT with alternative autograft choices [3, 11, 13].…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Fuimaono-Asafo

Frampton

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeTo evaluate the functional and graft survivorship outcomes of the three most common autograft options for primary anterior cruciate ligament reconstruction (ACLR)—hamstring tendon (HT), bone‐patella‐tendon‐bone (BPTB), and quadriceps tendon (QT). MethodsPatients captured by the New Zealand ACL registry who underwent a primary ACLR from 2014 to 2020 were considered for the study. Patients with associated knee injury (including meniscus, chondral, osseous, and additional ligamentous injury) and previous knee surgery were excluded. Comparison was made between HT, BPTB, and QT autografts with respect to Marx and KOOS (Knee Osteoarthritis Outcome Score) scores at minimum 2 years follow‐up. In addition, graft survivorship was evaluated by comparing all‐cause revision per 100 graft years and revision‐free proportion at 2 years post‐surgery. Results2,582 patients (1,921 HT, 558 BPTB, 107 QT) were included in the study. Differences in adjusted functional outcomes between HT and BPTB were found at 12 months (mean Marx; HT 6.2; BPTB 7.1; P < 0.001) (mean KOOS Sport and Recreation; HT 75.1; BPTB 70.5; n.s.) and 24 months (mean KOOS Sports and Recreation; HT 79.2; BPTB 73.9; P < 0.001). QT was comparable to HT and BPTB in all functional scores at 12 months and 2 years. No statistically significant differences were found in revision rate between all three autograft groups up to 2 years post‐surgery (revision rate per 100 graft years; HT 1.05; BPTB 0.80; QT 1.68; n.s. HT vs. BPTB; n.s. HT vs. QT; n.s. QT vs. BPTB). ConclusionsQT was found to be comparable to both HT and BPTB in all functional scores and revision rates up to 2 years post‐surgery. Level of evidenceLevel III.

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Less than 1% risk of donor-site quadriceps tendon rupture post-ACL reconstruction with quadriceps tendon autograft: a systematic review

Singh

Glassman²,

Sheean³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study is to develop a comprehensive complications profile for quadriceps tendon‐autograft anterior cruciate ligament reconstruction (QT ACL‐R). MethodsA traditional and grey literature search was conducted in accordance with PRISMA and R‐AMSTAR guidelines. PubMed, EMBASE, MEDLINE, CINAHL, Cochrane, Web of Science, and many grey literature sources were searched from inception to May 29, 2022. All studies were searched and screened in duplicate with included studies being of all levels of evidence, reporting complications, and with patients of all ages undergoing primary ACL reconstruction with quadriceps tendon autograft in the last 15 years. Studies were excluded if they had cadaveric or animal subjects or were reviews. Risk of bias assessment was conducted using MINORS criteria for non‐randomised studies and Cochrane’s RoB 2.0 for randomised studies. Data were summarised with weighted event rates generated under a random‐effects model. ResultsA total of 55 studies (5315 reconstructions) were included: 32 used quadriceps tendon with bone block (B‐QT), 19 used all‐soft tissue quadriceps tendon (S‐QT), and four did not report the QT graft subtype used. Included patients had an age range of 6.2–58 years and an average reported follow‐up time of 28.1 months (range, 6–90 months) for non‐randomised studies and 34.3 months (range, 0.233–120 months) for randomised studies. Pooled incidence rates for clinically relevant major complications included contralateral ACL injury at 6.0%, postoperative meniscal issues at 5.4%, cyclops lesions at 4.8%, graft failure at 4.1%, patellar fracture at 2.2%, hardware removal at 1.7%, infection at 1.5%, and donor‐site quadriceps tendon rupture at 0.7%. Pooled incidence rates for clinically relevant minor complications included anterior knee pain at 9.7%, kneeling pain at 9.5%, sensation deficits at 4.4%, loss of extension at 4.2%, donor‐site tendinopathy at 3.9%, cosmetic issues at 1.8%, and hematoma at 1.5%. ConclusionsQT ACL‐R resembles other graft types in its rates and types of postoperative complications. In this exploratory systematic review, no complications of QT ACL‐R were found to be disproportionately represented in the literature. This graft type should remain an option with comparable complication rates to other graft choices. Level of evidenceLevel IV. RegistrationThis study was preregistered under PROSPERO with preregistration code CRD42022302078.

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

Cited by 3 publications

References 21 publications

Grafts Comparison Between Quadriceps Tendon Autograft vs. Allograft for Anterior Cruciate Ligament Revisioon Reconstruction: A Literature Review

Grafts Comparison Between Quadriceps Tendon Autograft vs. Allograft for Anterior Cruciate Ligament Revisioon Reconstruction: A Literature Review

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

Less than 1% risk of donor-site quadriceps tendon rupture post-ACL reconstruction with quadriceps tendon autograft: a systematic review

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