The outcomes of quadriceps tendon autograft for anterior cruciate ligament reconstruction in adolescent athletes: a retrospective case series

Vaughn, Natalie H.; Dunleavy, Mark L.; Jackson, Trevor; Hennrikus, William L.

doi:10.1007/s00590-021-03032-x

Cited by 10 publications

(7 citation statements)

References 44 publications

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“…There was 1 study with level 1 evidence, 15 5 studies with level 2 evidence, 12 , 13 , 18 , 25 , 27 10 studies with level 3 evidence, ** and 4 studies with level 4 evidence. 11 , 23 , 24 , 46 The characteristics of the included studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…†† The second most common complication was the development of a cyclops lesion, with an estimated incidence of 4.9% (23 of 472 knees; reported in 4 studies). 5 , 17 , 18 , 25 The incidence of instability was estimated at 4.4% (9 of 206 knees; reported in 4 studies) 18 , 22 , 24 , 40 ; patellar fracture at 2.2% (n = 10 of 464 knees; reported in 5 studies) 14 , 18 , 23 , 24 , 46 ; ROM deficit at 2.2% (n = 11 of 500 knees; reported in 4 studies) 13 , 14 , 18 , 23 ; and infection at 1.4% (n = 4 of 286 knees; reported in 6 studies). 1 , 13 , 27 , 25 , 46 , 15 The surgical failure rate in the pooled sample was 3.1% at a mean 38.1-month follow-up (n = 72 of 2354 knees; reported in 19 studies).…”

Section: Resultsmentioning

confidence: 99%

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Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review

Jackson,

Mameri,

Tuthill

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament reconstruction (ACLR) surgery with quadriceps tendon (QT) grafts, both with and without a patellar bone plug, have gained popularity in recent years in the primary and revision settings. Postoperative complications occur with the use of QT autografts. Purpose: To systematically review the incidence of postoperative complications after primary ACLR QT autograft and compare complication rates in patients undergoing all-soft tissue QT grafts versus QT grafts with a patellar bone plug (QTPB). Study Design: Systematic review; Level of evidence, 4. Methods: A literature search using the 2020 PRISMA guidelines was performed by querying PubMed, Embase, and Scopus databases from database inception through August 2022. Included were evidence level 1 to 4 human clinical studies in English that reported complications after primary ACLR with QT autograft. The incidence of complications within the included studies was extracted. Differences in the incidence of postoperative complications between ACLR with QT with and without a patellar bone plug were calculated. Results: A total of 20 studies from 2004 to 2022, comprised of 2381 patients (2389 knees; 68.3% male) with a mean age of 27 years (range, 12-58 years), were identified. The mean follow-up was 28.5 months (range, 6-47 months). The total incidence of complications was 10.3%, with persistent postoperative knee pain being the most common (10.8%). Patients who underwent ACLR with all-soft tissue QT grafts had a 2.7-times increased incidence of anterior knee pain (23.3% vs 8.6%) and reoperations (5.9% vs 3.2%) when compared with QTPB grafts ( P < .01 for both). There was no appreciable difference in total complications, graft failures, ACLR revisions, cyclops lesions, or range of motion deficit ( P > .05 for all). Patellar fractures occurred exclusively after QTPB (2.2%). Conclusion: Complications after primary ACLR using QT autograft were recorded in 10.5% of knees, with anterior knee pain being the most common. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts; however, anterior knee pain was 2.7 times greater with use of a soft tissue quadriceps graft.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review

Jackson,

Mameri,

Tuthill

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…Maturation unknown/ undescribed (n = 2987) 31 (49%) 1,13,16,18,21,27,30,32,34,35,39,43,44,47,48,50,52,57,62,65,66,68,73,74,78,83,87,94,[97][98][99] Age, y 14.5 (range, 6.3-18.0) a Not all studies specified the numbers of girls and boys.…”

Section: Skeletal Maturationmentioning

confidence: 99%

Reconsideration of Return-to-Sport Decision-Making After Pediatric ACL Injury: A Scoping Review

Pauw

Buck

Gokeler

et al. 2023

Sports Health: A Multidisciplinary Approach

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Context: Up to 90% of pediatric athletes return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R); however, <50% RTS at the same level and second ACL injury rates are up to 32%. Objectives: (1) Determine which physical and patient-reported outcome measures guide clinical decision-making on RTS in pediatric athletes after ACL-R and (2) present a framework with insights from cognitive and neurophysiological domains to enhance rehabilitation outcomes. Data Sources: PubMed, CINAHL, Embrase, and Cochrane library databases and gray literature. Study Selection: Data on pediatric (<18 years) ACL-R patients, RTS, tests, and decision-making were reported in 1214 studies. Two authors independently reviewed titles and abstract, excluding 962 studies. Gray literature and cross-reference checking resulted in 7 extra studies for full-text screening of 259 studies. Final data extraction was from 63 eligible studies. Study Design: Scoping review. Level of Evidence: Level 4. Data Extraction: Details on study population, aims, methodology, intervention, outcome measures, and important results were collected in a data chart. Results: Studies included 4456 patients (mean age, 14 years). Quadriceps and hamstring strength (n = 25), knee ligament arthrometer (n = 24), and hop tests (n = 22) were the most-reported physical outcome measures guiding RTS in <30% of studies with cutoff scores of limb symmetry index (LSI) ≥85% or arthrometer difference <3 mm. There were 19 different patient-reported outcome measures, most often reporting the International Knee Documentation Committee (IKDC) (n = 24), Lysholm (n = 23), and Tegner (n = 15) scales. Only for the IKDC was a cutoff value of 85% reported. Conclusion: RTS clearance in pediatric ACL-R patients is not based on clear criteria. If RTS tests were performed, outcomes did not influence time of RTS. Postoperative LSI thresholds likely overestimate knee function since biomechanics are impaired despite achieving RTS criteria. RTS should be considered a continuum, and biomechanical parameters and contextual rehab should be pursued with attention to the individual, task, and environment. There is a need for psychological monitoring of the ACL-R pediatric population.

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“…Despite the advantages of the BPTB autograft, multiple studies have reported frequent donor site morbidity associated with this autograft, such as anterior knee pain, extension loss, PL rupture, and kneeling pain (Zhao et al, 2020). Some studies have concluded that the PL harvesting process can cause donor site morbidity (Vaughn et al, 2021). Damage to the infrapatellar branch of the saphenous nerve during the PL autograft harvesting process can also occur, causing reduced anterior knee sensitivity and anterior knee pain (Barié et al, 2020).…”

Section: Bone-patellar Tendon-bone Autograftmentioning

confidence: 99%

The patellar ligament: A comprehensive review

2021

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The patellar ligament (PL) is an epiphyseal ligament and is part of the extensor complex of the knee. The ligament has gained attention due to its clinical relevance to autograft and tendinopathy. A variety of anatomical variations of the PL such as aplasia, numerical variations, and vascularity are being reported recently by clinicians and anatomists. The aim of this literature was to review the available literature to provide a consensus regarding anatomic variations of the PL, neurovasculature surrounding the PL, histology of the PL, and various aspects of PL measurements with relevance to the surgical considerations and sex and age-related differences. A narrative review of the patellar ligament was performed by conducting a detailed literature search and review of relevant articles. A total of 90 articles on the patellar ligament were included and were categorized into studies based on anatomical variations, neurovasculature, morphometrics, microanatomy, sex and age-related difference, and ACL reconstruction. The anatomical variations and morphometrics of the PL were found to correlate with the frequency of strain injuries, tendinopathy, and efficacy of the PL autograft in anterior cruciate ligament reconstruction. The sex differences in PL measurements and the effect of estrogen on collagen synthesis explained a higher incidence of patellar tendinopathy in women. An awareness of its variations enables careful selection of surgical incisions, thereby avoiding complications related to nerve injury. Accurate knowledge of the PL microanatomy assists in understanding the mechanism of ligament degeneration, rupture, autograft harvesting, and ligamentization results.

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The outcomes of quadriceps tendon autograft for anterior cruciate ligament reconstruction in adolescent athletes: a retrospective case series

Cited by 10 publications

References 44 publications

Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review

Adverse Events and Complications After Primary ACL Reconstruction With Quadriceps Tendon Autograft: A Systematic Review

Reconsideration of Return-to-Sport Decision-Making After Pediatric ACL Injury: A Scoping Review

The patellar ligament: A comprehensive review

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