Summary

Quadriceps autograft tendon shows similar 2 year clinical results, patient reported outcomes and return to sport rates compared with hamstrings autografts used for anterior cruciate ligament reconstruction in the athletic population.

Abstract

Background

Numerous graft options are reported when undertaking anterior cruciate ligament reconstruction (ACLR), though a lack of high-quality evidence exists comparing quadriceps (QT) and hamstrings (HT) autografts.

Purpose

To investigate patient outcomes in patients undergoing HT versus QT ACLR.
Study Design: Randomized controlled clinical trial.

Methods

Following recruitment and randomization, 112 patients (HT=55, QT=57) underwent ACLR. Patients were assessed pre- and post-operatively (6 weeks and 3, 6, 12 and 24 months) with a range of patient-reported outcome measures (PROMs), graft laxity (KT-1000), active knee flexion and extension range of motion (ROM), peak isokinetic knee extensor and flexor strength and a 6-hop performance battery. Limb Symmetry Indices (LSIs) were calculated for strength and hop measures. Secondary procedures, ACL re-tears and contralateral ACL tears were reported.

Results

No group differences (p?0.05) were observed in demographics, injury or surgery history. All PROMs and knee ROM measures significantly improved (p<0.0001) though, apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score which was significantly better (p<0.05) in the HT group at 3, 6 and 12 months, no other group differences (p?0.05) were observed. No group differences were observed in side-to-side laxity (p=0.407), while there was no significant change in laxity from 6 to 24 months (p=0.105). While the HT group demonstrated significantly greater (p<0.05) quadriceps strength LSIs at 6 and 12 months, the QT group demonstrated significantly greater (p<0.05) hamstrings strength LSIs at 6, 12 and 24 months. The HT group demonstrated significantly greater (p<0.05) LSIs for the single horizontal (6 months), lateral (6 and 12 months) and medial (6 months) hop tests for distance. Up until 24-months, 1 patient (QT at 22 months) had suffered a re-tear, with 2 contralateral ACL tears (QT at 19 months, HT at 23 months). Secondary procedures included 5 in the HT group (MUA, notch debridement, meniscal repair) and 6 in the QT group (MUA, notch debridement, meniscal repair, tibial tubercle transfer, osteochondral autologous transplantation).

Conclusions

The two autograft groups compared well for PROMs (apart from the ACL-RSI), knee ROM and laxity. However, greater hamstring strength LSIs were observed for the QT cohort, with greater quadriceps strength (and hop test) LSIs in the HT cohort. Longer-term review will continue to evaluate RTS and later-stage re-injury between the two graft constructs.