Summary

Primary and revision ACL reconstruction with QT autografts had acceptable functional outcomes

Abstract

Background

The incidence of ACL reconstruction is increasing and quadriceps tendon (QT) autograft is gaining popularity for both primary and revision ACL reconstruction. Better patient-reported functional outcomes and a lesser graft failure rate are seen in primary ACL surgery as compared to revision surgery with the hamstring graft. No study compared primary and revision ACL surgery using QT autograft.

Purpose

The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, concomitant injuries and graft failure in primary and revision ACL surgery using the autologous QT graft. The hypothesis was that better functional outcomes, lesser concurrent injuries and lesser graft failure would be associated with primary ACL reconstruction compared to revision reconstruction.

Methods

376 patients with primary ACL reconstruction and 138 patients with revision ACL reconstruction were retrospectively retrieved from a prospectively collected ACL registry. A minimally invasive technique was used for QT autograft harvesting. The surgical procedure and rehabilitation protocol were identical in both groups. To maintain a homogeneous cohort for the study, the groups were matched for age, gender, and pre-injury outcome scores (Lysholm knee score, Tegner activity level and visual analogue scale for pain). Initial baseline assessments of outcome scores were compared to scores collected at the 2year postoperative mark.

Results

The mean age of the primary group and revision group was 32.9 ± 10.2 (range, 18-55) and 32.3 ± 9.9 (range, 19-55) respectively. Significant improvements were noted in Lysholm (p=0.007) and VAS (p=0.001) scores in primary ACL reconstruction compared to revision construction. However, no significant difference was found in Tegner activity level (p>0.05). Primary ACL injuries were associated with significantly higher MCL injuries (p=0.019), while, the revision group was associated with significantly higher cartilage (p=0.001) and meniscal injuries (p=0.003). A significantly higher graft failure rate was noted in the revision group compared to the primary ACL reconstruction group (p=0.005).

Conclusion

Both primary and revision ACL reconstruction with QT autografts had acceptable functional outcomes. The primary group had better outcomes than the revision group. The lower prevalence of meniscal and cartilage injuries in the primary group compared to the revision group may be responsible for better outcomes. The revision group was associated with higher graft failure than the primary group. QT autograft is a viable graft choice for both primary and revision ACL reconstruction.

Level of evidence: Level III Cohort Study