Summary
QTB ACLR at 10 years follow-up resulted in excellent patient satisfaction and functional outcomes. There were no significant differences with the healthy knee as to anterior and anterolateral rotational instability, ROM, muscle force and donor site morbidity.
Abstract
Purpose
To assess the outcomes of autograft quadriceps-tendon-bone (QTB) anterior cruciate ligament reconstruction (ACLR) performed with anteromedial portal technique at 10 years follow-up.
Methods
20 patients (16M, 4F, mean age 33,46 years, SD=13,07) after QTB ACLR were examined at the mean time of 123.2 months, min-max 120-139. Patient-reported satisfaction was measured by NRS score and functional results were assessed by IKDC and KOOS scores. Anterior tibial translation (ATT) was assessed among the patients without traumatic retear by the means of instrumented Lachman test (Rolimeter) and rotational instability was assessed by the pivot-shift test: grade 0 (normal), grade 1 (glide), grade 2 (clunk), or grade 3 (locking). Range of motion (ROM) was examined using the long-lever goniometer as well as by the ability to sit on dorsiflexed ankles and to perform a dynamic hyperextension. Maximal knee flexion and extension strength was tested isometrically using FK1K electronic dynamometer (Sauter, Swiss, measurement resolution 0.5N, maximum force 1000N). The donor site was inspected with the ultrasound to determine healing of the QT, with the dynamometer to determine the maximal force applied to graft donor site without pain and by pain during full squat. Data pertaining to the patients satisfaction and functional scores were analyzed to present the means and standard deviation (SD). In the rest of variables, the second knee was used as a comparison and therefore the following statistical tests were used: Shapiro-Wilk, Levene, t-student, U-Mann Whitney.
Results
At 10-year follow-up, patient satisfaction was high: mean NRS=9.25, SD=0.8. Mean KOOS was 82.84, SD=14.62, mean IKDC=75.43, SD=16.43. Traumatic retear rate was 4/20 (20%), with retears occurring at 3,4, 8 and 10 years postoperatively. In the remaining 16 patients, mean ATT in ACLR-knees was 4.1mm, SD=1.1mm, while in healthy knees it was 3.5, SD=0.9, p=0.14. Lachman’s test endpoint was hard in 13 and soft in 3 patients. Pivot-shift grade was 0 in 12 patients, grade 1 in 5 patients, and no patient had grade 2 or 3.
Mean passive ROM and muscle force did not differ significantly between ACLR-knees and healthy knees in terms of flexion (148.3, SD=5.6 vs. 150.1, SD=7.2, p=0,39), hyperextension (7.0, SD=3.2 vs 8.1, SD=2.4, p=0.24), maximal force of knee flexion (210.5N, SD=70.0N vs. 208.0N, SD=63.0N, p=0.89) and extension (265.0N, SD=63.5N vs. 262.5N, SD=59.5N, p=0.89). Eleven subjects could sit on dorsiflexed ankles with mean pain NRS of 1.5, SD=2.7. 19 patient could perform dynamic hyperextension.
The full-thickness healing of QT occurred in eleven patients, partial in seven patients and no healing in two. Bony part of the patella did not heal fully in any patient. Mean maximal force applied to the donor site without pain was 95.0N, SD=29.5 in ACLR-knees vs. 97.5N, SD=30.5N in healthy knees, p=0.81. Every patient was able to do a full-depth squat, with mean pain NRS of 1.05, SD=2.16.
Conclusion
QTB ACLR at 10 years follow-up resulted in excellent patient satisfaction and functional outcomes. There were no significant differences with the healthy knee as to anterior and anterolateral rotational instability, ROM, muscle force and donor site morbidity.