There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study

Runer, Armin; Wierer, Guido; Herbst, Elmar; Hepperger, Caroline; Herbort, Mirco; Gföller, Peter; Hoser, Christian; Fink, Christian

doi:10.1007/s00167-017-4554-2

Cited by 90 publications

(131 citation statements)

References 57 publications

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“…6,19,20 Several recent studies have directly compared the clinical outcomes of QT grafts versus quadrupled hamstring grafts, showing equivalent or superior functional outcomes and less postoperative donor-site pain with QT grafts. 19,21,22 This systematic review shows that since the introduction of the QT autograft by Marshall et al 4 in 1979, research regarding its use has been increasing steadily. This increase in research reflects the growth in popularity as an alternative choice for autograft tissue in ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Publications Regarding Quadriceps Tendon Autograft Use in Anterior Cruciate Ligament Reconstruction

Heffron

Hunnicutt

Xerogeanes

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Publications Regarding Quadriceps Tendon Autograft Use in Anterior Cruciate Ligament Reconstruction

Heffron

Hunnicutt

Xerogeanes

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The studies were not uniform in terms of the graft removal method and use of bone plug. Only one study 23 used a minimally invasive technique for graft removal with a suprapatellar transverse incision, while the others used a longitudinal route in the topography of the QT. Most studies used bone plug, except for Martin-Alguacil et al 26 Removal of Hamstring Graft.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Preparation of the tunnels and graft fixation. To create the femoral tunnel, two studies 21,22 used the transtibial technique, three studies 23,25,26 opted for the anteromedial portal at the anatomical point, and one of these 24 applied the outside in technique. The creation of the tibial tunnel, which was similar between groups, was performed at the native site of the ACL, medial to the lateral meniscus root and lateral to the medial tibial spine.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Postoperative rehabilitation. Three of the studies 22,23,25 used a hinged brace from two to six weeks postoperatively. Return to sports was described in only two studies, one within six months 22 and the other according to the hop test and muscle strength.…”

Section: Surgical Techniquementioning

confidence: 99%

“…It is possible to find similar clinical outcome and rate of complications between the two groups, with the advantage of lower donor site morbidity in the QT group. [16][17][18][19][20] Regarding studies comparing HT and QT, data in the literature are scarce, [21][22][23][24][25][26] particularly on comparative studies. The aim of this study is to perform a literature review comparing the clinical outcomes of patients undergoing anterior cruciate ligament reconstruction with QT versus HT.…”

Section: Introductionmentioning

confidence: 99%

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Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Salas

Oliveira

Lima

et al. 2020

Rev Bras Med Esporte

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Introduction: Anterior cruciate ligament injury is one of the most prevalent musculoskeletal injuries. Therefore, several surgical techniques and graft types have been described for its reconstruction. Autologous hamstring tendon graft is one of the most frequently used, but use of the quadriceps tendon graft has gained prominence in recent years. Objective: To review the literature to compare the outcomes of patients undergoing anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft versus hamstring tendon (HT) autograft. Methods: A literature review was conducted through PubMed to locate studies (Level of evidence I-III) comparing the outcomes of the QT autograft vs. the HT autograft in patients undergoing primary ACL reconstruction. Patients were assessed on the basis of re-rupture rate, ligament instability, patient-reported outcome scores, previous pain, and isokinetic tests. Results: Six studies were selected according to inclusion criteria. A total of 481 patients were evaluated, 243 in the QT group and 238 in the HT group. The total re-rupture rate was 1.6% (8 of 481), with 6 in the HT group and 2 in the QT group, but with no statistical difference between groups. One study found increased ligament instability in the HT group and another study found greater instability in the QT group, both with statistical significance. Regarding the patient-reported functional scores, only 01 study found statistical difference, with better results in the QT group. There was no difference in previous pain between groups in the selected studies. Regarding the isokinetic test, one study found a difference in flexor force in the HT group (p <0.01), with no difference in extensor force, while another two studies found an increased extensor force deficit in the QT group within up to 01 year of follow-up. The flexor/ extensor muscle strength ratio was higher in the QT group in both studies. Conclusion: ACL reconstruction with QT graft presents re-rupture rates, ligament instability, functional scores and donor site morbidity that are similar to the HT graft, in addition to preserving greater flexor force in proportion to extensor force. Level of evidence: IV; Review study.

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Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions

Zegzdryn,

Moatshe,

Engebretsen

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeBone patella‐tendon bone (BPTB) and hamstring tendon (HT) autografts are the most used grafts in primary anterior cruciate ligament (ACL) reconstructions (ACLR) in Norway. Quadriceps tendon (QT) autograft has gained more popularity during the past years. The purpose of this study is to compare revision rates and patient‐reported outcomes of primary QT with BPTB and HT autograft ACL reconstructions in Norway at 2‐year follow‐up. It was hypothesized that there would be no difference in 2‐year revision rates between all three autografts.MethodsData included primary ACLR without concomitant ligament surgeries, registered in the Norwegian Knee Ligament Register from 2004 through 2021. Revision rates at 2 years were calculated using Kaplan–Meier analysis. Hazard ratios (HR) for revision were estimated using multivariable Cox regression analysis with revision within 2 years as endpoint. Mean change in patient‐reported outcome was recorded preoperatively and at 2 years through the Knee Injury and Osteoarthritis Outcome Score (KOOS) subcategories ‘Sport’ and ‘Quality of Life’ was measured for patients that were not revised and analysed with multiple linear regression.ResultsA total of 24,790 primary ACLRs were identified, 10,924 with BPTB, 13,263 with HT and 603 with a QT graft. Patients in the QT group were younger (23.5 years), more of them were women (58.2%) and over 50% had surgery <3 months after injury. The QT group had the highest prevalence of meniscal injuries (61.9%). Revision estimates at 2‐years were 3.6%, 2.5% and 1.2% for QT, HT and BPTB, respectively (p < 0.001). In a Cox regression analysis with QT as reference, BPTB had a lower risk of revision (HR 0.4, 95% Cl 0.2–0.7, p < 0.001). No significant difference was observed in the revision risk between QT and HT (HR 1.1, 95% Cl 0.7–1.8, n.s.). The two most common reported reasons for revision were: traumatic graft rupture and nontraumatic graft failure. There were no differences between the groups in change of KOOS in subcategories ‘Sport’ and ‘Quality of Life’ at 2‐years follow‐up.ConclusionThe 2‐year risk of revision after ACLR with QT was higher than BPTB and similar to HT. No difference was found between the groups in patient‐reported outcomes. This study provides valuable insights for both surgeons and patients when making decisions about the choice of autografts in primary ACL reconstructions.Level of Evidence: Level II.

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There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study

Abstract: III.

Cited by 90 publications

References 57 publications

Systematic Review of Publications Regarding Quadriceps Tendon Autograft Use in Anterior Cruciate Ligament Reconstruction

Systematic Review of Publications Regarding Quadriceps Tendon Autograft Use in Anterior Cruciate Ligament Reconstruction

Quadriceps Autograft in Anterior Cruciate Ligament Reconstruction: A Literature Review

Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions

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