Summary

Complications following primary ACLR using quadriceps tendon autograft were recorded in 10.5% of knees, with persistent knee pain being most common. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts, however persistent knee pain was 2.7x greater with use of a soft tissue quadriceps graft.

Abstract

Background

Anterior cruciate ligament reconstruction (ACLR) surgery with quadriceps tendon (QT) grafts – both with and without a patellar bone plug - have gained popularity in recent years in both the primary and revision setting. Nevertheless, with the use of QT autografts, postoperative complications occur.

Purpose

To systematically review the incidence of postoperative complications following primary anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon autograft, while comparing complication rates in patients undergoing all-soft tissue quadriceps tendon (QT) grafts versus quadriceps tendon grafts with a patellar bone plug (QTPB).

Study Design: Systematic Review; Level of Evidence IV

Methods

A literature search was performed by querying PubMed, Embase, and Scopus databases from database inception through August 2022 using the 2020 PRISMA guidelines. Inclusion criteria consisted of level I to IV human clinical studies in English or English-language translation reporting complications following primary ACLR using quadriceps tendon autograft. The incidence of complications within the included studies was extracted. Differences in the incidence of postoperative complications between ACLR with quadriceps tendon with and without a patellar bone plug were calculated.

Results

Twenty studies from 2004-2022, comprised of 2,381 patients (n=2,389 knees) with a mean age of 27 (mean range, 12 - 58) years, consisting of 68.3% males, were identified. The mean follow-up was 28.5 (mean range, 6 – 47) months. The total incidence of complications was 10.3%, with persistent post-operative knee pain being most common (10.8%). Patients who underwent ACLR with all-soft tissue QT grafts had a 2.7x increased incidence of persistent knee pain (23.3% versus 8.6%) and reoperations (5.9% versus 3.2%) when compared to QTPB grafts (both, p < .01). There was no appreciable difference in total complications, graft failures, ACLR revisions, cyclops lesions, or range of motion deficit (all, p > 0.05). Patellar fractures occurred exclusively following QTPB (2.2%).

Conclusion

Complications following primary ACLR using quadriceps tendon autograft were recorded in 10.5% of knees, with persistent knee pain being most common. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts, however persistent knee pain was 2.7x greater with use of a soft tissue quadriceps graft.