Revision Anterior Cruciate Ligament Reconstruction with the All-Soft Tissue Quadriceps Tendon Autograft Has Acceptable Early and Intermediate-Term Outcomes

Hunnicutt, Jennifer L.; Haynes, W.B.; Slone, Harris S.; Prince, Janelle A.; Boden, Stephanie; Xerogeanes, John W.

doi:10.1016/j.arthro.2021.03.035

Cited by 15 publications

(27 citation statements)

References 51 publications

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“…3,12,16,26 Fewer data exist regarding the use of ASTQT autografts in revision ACL reconstruction. However, a study by Hunnicutt et al 17 found that ASTQT autograft for revision ACL reconstruction exhibited acceptable early and intermediate-term clinical and functional outcomes. In that series, IKDC scores significantly improved over the study period, and the mean score at 2 years after operation was 82.8, which is comparable with the 82.9 two-year mean IKDC score observed in our cohort.…”

Section: Discussionmentioning

confidence: 99%

All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up

et al. 2022

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Background: Revision anterior cruciate ligament (ACL) reconstruction is being performed at an increasing rate. Previous literature has suggested that autograft ACL reconstruction is a better option than allograft in revision surgery, although the optimal autograft choice remains unknown. The all–soft tissue quadriceps tendon (ASTQT) autograft has been found to be an effective option for primary ACL reconstruction. However, few studies have evaluated ASTQT autograft in revision ACL reconstruction. Purpose/Hypothesis: The purpose of this study was to evaluate the ASTQT autograft in revision ACL reconstruction in athletes compared with bone–patellar tendon–bone (BTB) autograft. We hypothesized that the ASTQT autograft would lead to similar return to play, time to return to play, retear rate, and patient-reported outcomes compared with BTB autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed on all athletes undergoing revision ACL reconstruction between August 2013 and December 2019 at a single institution. Patients participating in high school or college athletics undergoing first-time revision with either ASTQT or BTB autograft with ≥2 years of follow-up were included. Demographic variables, complications, return to sports, and outcome scores including the International Knee Documentation Committee (IKDC) and Lysholm were collected and compared between the 2 cohorts. Results: A total of 58 revision ACL reconstructions were included, with 32 in the ASTQT cohort and 26 in the BTB cohort. Return to sports at the same level occurred in 62.5% of the ASTQT group and 53.8% of the BTB group. The ASTQT group returned to sports significantly faster than the BTB group (8.9 vs 10.3 months; P = .020). There was no difference in retear rates (3.1%, ASTQT; 7.7%, BTB) or other complications between the 2 groups. The IKDC scores were significantly higher at the 6- and 12-month follow-up for the ASTQT autograft group compared with the BTB group (6 months: ASTQT, 71.3; BTB, 61.7, P = .001; 12 months: ASTQT, 82.7; BTB, 78.6; P = .021). Lysholm scores were also greater in the ASTQT cohort at these time points (6 months: ASTQT, 75.1; BTB, 63.6; P < .001; 12 months: ASTQT, 82.0; BTB, 74.5; P < .001). However, IKDC and Lysholm scores were similar between both groups at final follow-up (IKDC: ASTQT, 82.9; BTB, 81.7; P = .344; Lysholm: ASTQT, 83.0; BTB, 81.0; P = .104) There was no significant clinical difference in the absolute difference in scores or rate of achieving clinical thresholds between the 2 cohorts. Conclusion: ASTQT autograft for revision ACL in athletes has similar outcomes compared with BTB autograft. However, the ASTQT may possibly afford quicker return to sports and better early improvements in patient-reported outcomes that normalize by 1 year. The soft tissue quadriceps autograft should be considered a viable graft option in revision ACL reconstruction in athletes.

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Section: Discussionmentioning

confidence: 99%

All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up

et al. 2022

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“…Traveling proximally from the superior pole of the patella (SPP), the QT width gradually decreases from about 43 mm at the insertion on the patella to 11 mm at 7 cm proximal ( Fig 1 ). 10 The point of maximal tendon length is 61%, on average, from the medial border of the QT insertion on the patella, to the lateral insertion but can be variable, making the central portion of the tendon difficult to find from a distal starting point. 11 Angulation outside of the natural quadriceps (Q) angle can increase the risk for inadvertent short graft harvest.…”

Section: Anatomy and Biomechanicsmentioning

confidence: 99%

“…The minimally invasive QT graft using a proximal-to-distal harvest is a safe and reproducible approach for both primary and revision ACL reconstruction. 10 …”

mentioning

confidence: 99%

Minimally Invasive Anterior Cruciate Ligament With Quadriceps Tendon Graft: A Proximal-to-Distal Harvest Technique

Panas

Salomon

Shen

et al. 2022

Arthroscopy Techniques

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“…ACL revision cases are difficult and, as in any clinical scenario in medicine, when there are multiple viable options, inherently, there is no one correct answer. In this elegant study, "Revision Anterior Cruciate Ligament Reconstruction With the All-Soft Tissue Quadriceps Tendon Autograft Has Acceptable Early and Intermediate-Term Outcomes" by Hunnicutt, Haynes, Slone, Prince, Boden, and Xerogeanes, 4 the authors not only demonstrated quadriceps autograft as a viable graft option for revision cases, but they were able to demonstrate no significant differences in quadriceps or hamstring limb symmetry index (LSI) strength ratios between patients with previous hamstring (HT) vs patella tendon (BPTB) autografts. The authors provide a timely study in a well-written article advocating for the use of soft tissue quadriceps autograft in revision ACLR cases.…”

Section: See Related Article On Page 2848mentioning

confidence: 99%

Editorial Commentary: Revision Anterior Cruciate Ligament Using Soft Tissue Autograft Quadriceps Is Effective but Not Recommended for All Comers

Shah¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The average revision rate is between 3.2% and 11.1%following primary anterior cruciate ligament (ACL) reconstructions, 1 and an objective failure rate of 13.7% has been reported for revision ACLR. 2 Prior implants, positioning of tunnels, and muscle weakness from the prior reconstruction present challenges. Additionally, graft choice for the revision reconstruction is restricted, depending on the primary reconstruction. Revision ACL reconstruction with the allsoft tissue quadriceps tendon autograft is a viable option with 83.3% of the patients surpassing the minimally clinically significant difference for International Knee Documentation Committee (IKDC) scores, which is similar to outcomes for revision ACL reconstruction (ACLR) using bone-patella-bone and hamstring tendon autografts. Furthermore, objective strength data suggest that it is possible to achieve equal limb symmetry index strength ratios even in the setting of prior bone-patella tendon-bone autograft. However, although I am cautiously optimistic regarding soft tissue quadriceps autograft in revision ACLR, I would be hesitant to recommend it for all comers. In my experience, young high school/ collegiate female athletes with primary reconstruction using BPTB autograft may not be able to tolerate a secondary insult to the extensor mechanism via quadriceps tendon (QT) autograft harvest, where hematoma and arthrofibrosis could be concerns. Furthermore, increased posterior tibial slope may require evaluation and treatment, and the addition of a lateral extra-articular tenodesis may reduce residual rotatory laxity in ACL revision patients.

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Revision Anterior Cruciate Ligament Reconstruction with the All-Soft Tissue Quadriceps Tendon Autograft Has Acceptable Early and Intermediate-Term Outcomes

Cited by 15 publications

References 51 publications

All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up

All-Soft Tissue Quadriceps Tendon Autograft in Revision Anterior Cruciate Ligament Reconstruction in Athletes: Comparison to Bone-Patellar Tendon-Bone Autograft With at Least a 2-Year Follow-up

Minimally Invasive Anterior Cruciate Ligament With Quadriceps Tendon Graft: A Proximal-to-Distal Harvest Technique

Editorial Commentary: Revision Anterior Cruciate Ligament Using Soft Tissue Autograft Quadriceps Is Effective but Not Recommended for All Comers

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