Summary

This study investigates the performance of QT vs HT autografts with respect to achieving clinically meaningful outcomes and return to sport.

Abstract

Purpose

To investigate the potential association between performing ACL reconstruction with HT or QT autograft, propensity for achievement of clinically meaningful outcomes, and return to sport (RTS).

Methods

Thirty patients undergoing ACL reconstruction with QT autograft were matched by age, sex and body mass index to 62 patients undergoing ACL reconstruction with HT autograft. Clinical outcomes including the International Knee Documentation Committee (IKDC) score, Marx scale, Single Assessment Numeric Evaluation (SANE), and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Mobility scores, and metrics concerning RTS were collected. The minimal clinically important difference was calculated for each outcome measure using the distribution-based method equivalent to one-half the standard deviation of the change in outcome score at a minimum of one-year follow-up. Appropriate parametric or non-parametric testing was applied to compare the outcome measures, MCID rates and RTS metrics between the two cohorts.

Results

Fifty-four patients (60.0%) were male and the mean age was 22.6 ± 6.8 years. No statistically significant differences were observed in preoperative or postoperative clinical outcome scores, nor the net change in these scores. Furthermore, no significant differences were observed in rates of MCID achievement for the IKDC (QT:90%, HT:93.5%), SANE (QT:90%, HT:88.7%), Marx (QT:93.3%, HT:90.3%), PROMIS PI (QT:96.6%, HT:95.2%), and PROMIS Mobility (QT:79.3%, HT:90.3%). The mean time to RTS was 9.1 ± 2.2 months. Mean time to RTS did not significantly differ between cohorts (QT:9.2 ± 2.4, HT:9.0 ± 2.9,p=0.75). The most common reason for failing to RTS in the HT cohort was not being given clearance (34.5%), while the most common reason in the QT cohort was other reasons outside of their health not related to their knee (38.5%). Notably, satisfaction with overall outcome (QT:96.6%, HT:95.1%,p=0.59) and kinesiophobia RTS after injury scores (QT:64.2 ± 27.6 vs. HT:59.4 ± 24.6, p=0.40) did not differ between the cohorts.

Conclusion

The use of QT autograft in ACL reconstruction is a reasonable alternative to HT autograft as it confers similar rates of clinically meaningful improvement and RTS at short-term follow-up.