Summary

There is no statistically significant difference in patient-reported outcome measurements, revision- or contralateral surgery between patients treated with bone- quadriceps tendon or soft-tissue-quadriceps tendon autograft.

Abstract

Purpose

To compare patient reported outcome measurements (PROMs) and reoperation rates in patients treated with soft tissue quadriceps tendon autograft (S-QT) or quadriceps tendon autograft with bone block (B-QT) in anterior cruciate ligament reconstruction (ACL-R).

Methods

All ACL-Rs performed between January 2010 and December 2020 at a single specialized orthopaedic center were recorded in a prospectively administered Microsoft (MS) Access-based database. Patient-administered questionnaires including Visual Analogue Scale (VAS) for pain, Lysholm score and Tegner activity score were obtained preoperatively and at 6, 12 and 24 months postoperative as revision- and contralateral ACL-R were recorded. Preinjury physical activity level was measured with the Tegner Activity Scale and classified as low (<3), medium (4-6), and high (=7). All patients were grouped into 4 age categories: <15, 15-30, 31-45, >45 years. Besides ACL graft ruptures, concomitant injuries to cartilage and menisci were recorded.
Binary logistic regression was used to assess the influence of the following factors on the need to undergo revision surgery or ACLR on the contralateral limb: graft preparation technique, age group, preinjury Tegner activity level, sex, and additional surgical interventions. Additional Mann-Whitney U- and chi-square test were used for between group comparison.

Results

A total of 556 patients (45.6% female) with primary QT-A ACLR were included in the study. Out of those 347 49.5% (n=347) where treated with B-QT and 50.5% (n=345) with S-QT. Mean age was 29.1 ± 13.0 and 31.4 ± 12.2 (p=.04), respectively. Both groups did not differ preoperatively with regards to gender, sports activity level, time from injury to surgery or additionally performed interventions.
At final follow-up no statistical differences between both groups were observed in VAS for pain (median [range] B-QT: 0 [0-6]; S-QT: 0 [0-8] , Lysholm score (B-QT-BB: 87.5±20.9; S-QT: 88.2±17.6), Tegner activity level (median [range] B-QT: 6 [2-10]; S-QT: 6 [1-10]) and rate of return to preinjury Tegner activity level (B-QT: 67.6%; S-QT-ST: 67.2%).
Revision surgery- (B-QT: 12.8%, n=3; S-QT: 2.9%, n=3) or contralateral ACL reconstructions rates (B-QT: 2.8%, n=7; S-QT: 3.9, n=9) did not different between both groups.
Neither graft type, age, preinjury Tegner activity score, sex or additional surgical interventions had a significant value in predicting the need for revision- or contralateral ACL surgery.

Conclusion

There is no statistically significant difference in patient-reported outcome measurements, revision- or contralateral surgery between patients treated with bone- quadriceps tendon or soft-tissue-quadriceps tendon autograft. Neither graft type, age at time of surgery, preinjury Tegner activity level, sex or additional surgical interventions had a significant value in predicting the need for revision- or contralateral ACL surgery.