Summary

No differences in clinical outcomes were observed between patients who received all-soft tissue QT autograft and QT autograft with a bone block, and the excellent results seen with both preparations suggest the use of either should follow surgeon discretion

Abstract

Introduction

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

Methods

A retrospective review of all patients undergoing QT autograft 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 grade, return to sport (RTS), postoperative complications, and other patient reported outcomes (PROs). p<0.05 was considered significant.

Results

Of 727 QT ACLRs screened, a total of 211 primary ACLR patients met criteria for analysis (163 bQT; 48 sQT). Females comprised a higher percentage of the sQT cohort (sQT: 50%, bQT: 33%; p <0.05). The sQT cohort underwent more concomitant procedures (sQT: 68%, bQT: 48%; p <0.05) and had a greater proportion of partial thickness autografts (sQT: 79%, bQT: 48%; p<0.05). All other baseline characteristics were statistically similar between cohorts. Pre-operative IKDC scores were comparable between cohorts (sQT: 37.3 ± 17.3, bQT: 40.5±19.3; p>0.05), as were mean pre-/postoperative difference (sQT: 44.6±21.9, bQT: 38.1±25.4; p>0.05), and number meeting MCID (sQT: 88%, bQT: 86%; p>0.05). Mean changes in other patient-reported outcomes, results of postoperative stability testing, and RTS metrics were similar between cohorts, including full RTS rate (sQT: 75%, bQT: 71%; p>0.05) and months to full RTS (sQT:10.5±4.1, bQT: 11.1±3.9; p>0.05). Clinical failure occurred in 6% of sQT patients and 6% of bQT patients; all failures were due to graft retear rather than persistent laxity. There were also no differences in postoperative stiffness or other postoperative complications.

Discussion

There were no differences observed in clinical outcomes between patients who underwent ACLR with sQT versus bQT. Currently, the decision to employ QT-ST or QT-BB is largely determined by surgeon preference. This study demonstrates excellent outcomes with both preparations and supports the use of either graft type at the discretion of the treating surgeon.