Summary

A novel systematic review exploring complication rates of quadriceps tendon ACL-R

Abstract

Purpose

While the functional outcomes associated with quadriceps tendon anterior cruciate ligament reconstruction (QT ACL-R) have been reported extensively, there is a relative paucity in the literature regarding peri- and postoperative complications of the procedure. The purpose of this study is to develop a comprehensive complications profile for QT ACL-R.

Methods

A traditional and grey literature search was conducted in accordance with PRISMA and R-AMSTAR guidelines. PubMed, EMBASE, MEDLINE, CINAHL, Cochrane, Web of Science, and a variety of grey literature sources were searched from inception to May 29, 2022. All studies were searched and screened in duplicate with included studies being of all levels of evidence, reporting complications, and with patients of all ages undergoing primary ACL reconstruction with quadriceps tendon autograft in the last 15 years. Studies were excluded if they had cadaveric or animal subjects or were review articles. Risk of bias assessment was conducted using MINORs criteria for non-randomized studies and Cochrane’s RoB 2.0 for randomised studies.

Results

A total of 55 studies (with 5315 patients) were included: 32 used quadriceps tendon with bone block (B-QT), 19 used all-soft tissue quadriceps tendon (S-QT), and four did not report the QT graft subtype used. Included patients had an age range of 6.2-58 years and an average reported follow-up time of 28.1 months (range, 6 to 90 months) for non-randomized studies and 34.32 months (range, 0.233 to 120 months) for randomised studies. Pooled incidence rates for clinically relevant major complications included contralateral ACL injury at 6.0% (95% CI, 3.4% to 10.4%), postoperative meniscal issues at 5.4% (95% CI, 3.1% to 9.3%), cyclops lesions at 4.8% (95% CI, 3.8% to 6.2%), graft failure at 4.1% (95% CI, 3.1% to 5.4%), patellar fracture at 2.2% (95% CI, 1.0% to 4.9%), hardware removal at 1.7% (95% CI, 0.8% to 3.7%), infection at 1.5% (95% CI, 0.9% to 2.5%), and donor site quadriceps tendon rupture at 0.7% (95% CI, 0.3% to 1.8%). Pooled incidence rates for clinically relevant minor complications included anterior knee pain at 9.7% (95% CI, 5.1% to 17.9%), kneeling pain at 9.5% (95% CI, 3.5% to 22.2%), sensation deficits at 4.4% (95% CI, 1.4% to 12.8%), loss of extension at 4.2% (95% CI, 2.3% to 7.7%), donor site tendinopathy at 3.9% (95% CI, 1.9% to 7.7%), cosmetic issues at 1.8% (95% CI, 0.1% to 22.4%), and hematoma at 1.5% (95% CI, 0.7% to 3.1%).

Conclusions

QT ACL-R resembles other graft types in its rates and types of postoperative complications. In this exploratory systematic review, no complications of QT ACL-R were found to be disproportionately represented in the literature. This graft type should remain a reliable option in a breadth of patients.