Summary
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.
Abstract
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.
Methods
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.
Results
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.
Conclusion
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.