Summary

In this study, we report complications encountered with soft tissue QTA for ACLR. Although the use of a QTA has recently gained popularity due to its high return to sports and low graft failure rate, surgeons must be aware of the complications and risks associated with QTA harvest.

Abstract

Objectives: The purpose of this study was to analyze the complications and subsequent procedures encountered with soft tissue quadriceps tendon autograft (QTA) for anterior cruciate ligament reconstruction (ACLR) in patients =18 years old.

Methods

A consecutive series of patients who underwent ACLR with a QTA with minimum 6 month-follow up were included. All patients underwent ACLR with a full thickness soft tissue QTA without a bone plug. Complications associated with the QTA harvest site and use of QTA were reported.

Results

A total of 143 pediatric patients =18 years old underwent an ACLR with a soft tissue QTA during the study period. Of these, 137 patients had minimum 6-month follow-up and were included. Six patients (4%) were deemed lost to follow-up and excluded. The mean age was 14.8±1.6 (11-18 years) and 60% were male. The average follow-up time was 2.0±1.1 years (0.5-4.9 years). Of the 137 patients included, 11 (8%) had a subsequent complication associated with the use of a QTA.

Eight (6%) patients had a subsequent procedure to remove non-absorbable sutures used for the donor site closure. We encountered a subset of patients that developed persistent donor site irritation and pain associated with the use of non-absorbable sutures and consequently changed our technique to use absorbable sutures.

Two (1%) patients developed osteochondritis dissecans (OCD) lesions in the superior aspect of the patella 1.2±0.8 years on average following surgery. We speculate that the QTA harvest could have compromised the vasculature of the patella, resulting in the development of OCD and subsequent chondromalacia.

Two (1%) patients had quadriceps tendon ruptures following QTA ACLR. One patient, fell onto a hyperflexed knee 6 weeks after QTA ACLR and sustained a small boney avulsion injury of the superior pole of the patella. Another patient sustained a non-contact injury while playing football 7 months post-operatively prior to being cleared to return to sports. They sustained a complete tear of the distal quadriceps tendon, adjacent to the donor site.

Of note, 1 patient underwent a concomitant removal of non-absorbable sutures and patellar chondromalacia debridement and is thus represented twice. In addition, 5 (4%) patients had a graft failure and underwent subsequent revision ACLR, 6 (4%) had a second meniscus-related surgery, 8 (6%) had a subsequent lysis of adhesions procedure, and 13 (9%) underwent contralateral ACLR.

Conclusion

In this study, we report complications encountered with soft tissue QTA for ACLR. The complication rate for QTA harvest was 8%. However, given that the removal of non-absorbable sutures from the donor site was caused by the surgical technique used, the revised complication rate for QTA harvest was 3%. To the authors’ knowledge, this is the first study to raise the suspicion that QTA harvest could lead to the development of superior patellar OCD as this occurred in two patients from this cohort. Although the use of a QTA has recently gained popularity due to its high return to sports and low graft failure rate, surgeons must be aware of the complications and risks associated with QTA harvest.