Summary

No differences in clinical outcomes were observed between patients undergoing revision ACLR with sQT versus bQT. Our findings support excellent outcomes with both preparations, demonstrating that both QT preparations are viable options in the revision setting.

Abstract

Purpose

There is little evidence supporting preferential use of soft tissue quadriceps tendon (QT) autograft (sQT) versus bone block QT autograft (bQT) for revision anterior cruciate ligament reconstruction (revision ACLR). The purpose of this study was to compare clinical outcomes between patients undergoing revision ACLR with sQT versus bQT. We hypothesized that there would be no difference in clinical outcomes.

Methods

A retrospective review of all patients undergoing QT autograft revision ACLR at a single institution between 2010-2021 was conducted. Patients with < 1 year follow-up, multi-ligamentous injury, double-bundle ACLR, posterolateral bundle augmentation, osteochondral procedures, osteotomy, or lateral extra-articular tenodesis were excluded. Primary outcomes were mean pre- and postoperative International Knee Documentation Committee (IKDC) score, mean difference between IKDC scores, and number of patients meeting minimum clinically important difference (MCID). Secondary outcomes included Lachman and pivot shift (PS) grade, instrumented laxity measured by KT-1000 arthrometer, return to sport (RTS), postoperative complications, and other patient reported outcomes (PROs). p<0.05 was considered significant.

Results

Of 727 QT ACLRs screened, 58 revision ACLR patients met criteria for analysis (42 bQT; 16 sQT, mean follow-up: 22.8±13.3 months). More bQT patients underwent surgery <3 months from their injury (bQT: 81% vs sQT: 50%; p< 0.05). All other baseline characteristics were statistically similar. There were no statistically significant differences in mean IKDC change (sQT: 17.2±21.9, bQT: 40.2±18.9, p>0.05) or number of patients who met MCID (NBB: 67%, BB: 100%, p>0.05). Mean changes in other PROs were likewise statistically similar between the sQT and bQT cohorts. Results of postoperative stability testing showed a comparable number of patients with positive Lachman (sQT: 5%, bQT: 13%, p>0.05) and positive PS (sQT: 17%, bQT: 29%, p>0.05) at final follow-up, as well as similar side-to-side KT-1000 differences postoperatively. The rate of full RTS was =50% in both cohorts (sQT: 50%, bQT: 69%, p>0.05) and months to achieve full RTS was comparable (sQT: 11.8±3.1, bQT: 11.4±3.2; p>0.05). 10% of the sQT cohort experienced clinical failure compared to 25% of the bQT cohort (p>0.05). Other postoperative complications also occurred at similar rates.

Conclusion

No differences in clinical outcomes were observed between patients undergoing revision ACLR with sQT versus bQT. Our findings support excellent outcomes with both preparations, demonstrating that both QT preparations are viable options in the revision setting.