ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper


Quadriceps Tendon- Vs. Hamstring Tendon Autograft In Primary Anterior Cruciate Ligament Reconstruction: A Matched-Pairs Study With A Mean Follow-Up Of 6.5 Years

Armin Runer, MD, Innsbruck GERMANY
Aline Suter, MD, Innsbruck AUSTRIA
Tommaso Roberti di Sarsina, MD, Bologna ITALY
Caroline Hepperger, Mag., Innsbruck AUSTRIA
Peter Gföller, MD, Innsbruck AUSTRIA
Christian Hoser, MD, Innsbruck AUSTRIA
Robert Csapo, PhD, Hall AUSTRIA
Christian Fink, MD, Prof., Innsbruck AUSTRIA

Gelenkpunkt - Sports and Joint Surgery, Innsbruck, AUSTRIA

FDA Status Not Applicable


The use of Quadriceps tendon autograft in isolated, primary anterior cruciate ligament reconstruction leads to equal clinical, functional and patient-reported outcomes but to less donor site morbidity when compared to hamstring tendon autografts.


Objectives: To compare clinical and functional outcomes of patients after primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon- (QT-A) and hamstring tendon (HT-A) autograft with a minimum follow-up (FU) of 5 years.


Between 2010 - 2014, all patients undergoing ACLR (QT: 119, HT: 511) were recorded in a prospectively administered database. All patients with primary, isolated QT-A ACLR and without any concomitant injuries or high grade of osteoarthritis were extracted from the database and matched to patients treated with HT-A. Re-rupture rates, anterior-posterior (ap) knee laxity, single-leg-hop test (SLHT) performance, distal thigh circumference (DTC) and patient reported outcome measurements (PROMs) were recorded. Between-group comparisons were performed using chi-square-, independent-samples T- or Mann-Whitney-U tests.


45 QT-A patients were matched to 45 HT-A patients (n=90). The mean FU was 78.9±13.6 months. 18 patients (20.0% / QT: N=8, 17.8%; HT: n=10, 22.2%; p=.60) sustained a graft rupture and 17 subjects (18.9% / QT: n=9, 20.0%; HT: n=8, 17.8%; p= .79) suffered a contralateral ACL injury. In high active patients (Tegner-activity-level=7) the rerupture rate increased to 37.5% (HT-A) and 22.2% (QT-A; p=.32). No statistical between-group differences were found in ap knee laxity side-to-side (SSD) measurements (QT-A: 1.9±1.2mm, HT-A: 2.1±1.5mm; p=.60), subjective IKDC- (QT: 93.8±6.8, HT: 91.2±7.8, p=.17), Lysholm- (QT: 91.9±7.2, HT: 91.5±9.7, p=.75) or any of the five subscales of the KOOS score (all p>.05). Furthermore, Tegner-activity-level (QT: 6(1.5), HT: 6(2), p=.62), VAS for pain (QT: 0.5±0.9, HT: 0.6±1.0, p=.64), Shelbourne-Trumper-Score (QT: 96.5±5.6, HT: 95.2±8.2, p=.50), Patient-and-Observer-Scar-Assessment-Scale (POSAS) (QT: 9.4±3.2, HT: 10.7± 4.9, p=.24), SSD-DTC (QT: 0.5±0.5, HT: 0.5±0.6, p=.97), return to sports rates (QT-A: 82.1%, HT-A: 86.7%) and SLHT (QT: 95.9±3.8%, HT-A: 93.7±7.0%) did not differ between groups. Length of skin incision (HT-A: 3.1 ± 0.6cm, QT-A: 1.8 ± 0.6cm; p<.001) was significantly longer and donor site morbidity (HT-A n=14, 46.7%; QT n=3, 11.5%; p=.008) significantly lower in the QT-A group.


Patient-reported outcome measures, knee laxity, functional testing results and re-rupture rates are similar between patients treated with QT- and HT- autografts. However, patients with QT-autograft have smaller tibial skin incisions and lower postoperative donor site morbidity.

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