Purpose

Graft choice for anterior cruciate ligament (ACL) reconstruction remains controversial. While quadriceps tendon (QT) autograft has emerged as an alternative graft choice, there remains a paucity of data regarding comparative outcomes. The current study compares subjective outcomes and complications of ACL reconstruction (ACLR) using either bone-patellar tendon-bone (BPTB) or QT autograft. Our hypothesis is that there will be no difference in subjective outcome or complications between groups.

Methods

Following IRB approval, retrospective analysis of prospectively collected data identified consecutive cohorts of patients undergoing ACLR with either BPTB or QT autograft. Surgeries were performed by a single fellowship trained sports surgeon between 2011-2019. Patients undergoing concomitant osteotomies, cartilage restoration, and other ligament reconstruction procedures were excluded. Patients with less than 12-month follow-up were also excluded. Pre- and post-surgical patient reported outcomes (PROs) including IKDC, KOOS, PROMIS, SANE, Tegner, and Marx were compared between groups. Complications requiring reoperation (stiffness and reconstruction failure) were recorded. Results were analyzed statistically.

Results

Eighty-five patients met inclusion criteria. There were 39 QT autografts and 46 BPTB autografts. Mean age was lower in the QT group than in the BPTB group (18.5 ± 6.0 years, 21.6 ± 7.4 years, p=0.04). Patient’s mean height was lower in the QT autograft group (166.6 ± 11.9 cm, 173.2 ± 8.3 cm, p=0.003). Sixteen of 39 (41.0%) in the QT group and 19 of 46 (41.3%) in the BPTB group were female (p=1.0). Mean BMI was 25.9 kg/m2 in both groups (p=1.0). Mean follow-up was comparable between groups (21.9 ± 10.6 months, 25.6 ± 14.5 months, p=0.2). Pre-operative KOOS Pain (69.9, 81.0, p<0.02) scores were significantly higher in the BPTB cohort. There were no differences in other baseline PROs. At minimum 12-month follow-up (range 12.0-66.1 months), patients in both the QT autograft and BPTB autograft cohorts reported statistically significant improvements in all KOOS domains, Tegner (96.1%, p<0.001; 98.5%, p<0.001), IKDC (63.7%, p<0.001; 58.8%, p<0.001), SANE (84.0%, p<0.001; 81.5%, p<0.001), PROMIS Mobility T-Score (27.2%, p<0.001; 26.1%, p<0.001), PROMIS Global Physical Health (14.6%%, p=0.002; 11.8%, p=0.01), PROMIS Physical Function (31.0%, p<0.001; 33.4%, p<0.001), PROMIS Pain Interference (-17.2%, p<0.001; -19.7%, p<0.001). QT group reported statistically significant reduction in Marx scores (-25.0%, p=0.04). Post-operative Global Mental Health (56.0, 60.1, p=0.02) scores were significantly higher in the BPTB cohort. Complications were low and not significant between groups. Both QT and BPTB autograft cohorts required postoperative re-operations (7.7% and 10.9%, p=0.6). The QT cohort underwent 2 subsequent ligament reconstructions (5.1%) and 1 surgery for stiffness (2.6%). The BPTB cohort underwent 3 ligament reconstructions (6.5%) and 2 surgeries for stiffness (4.3%).

Conclusion

Patients undergoing either BPTB or QT autograft ACLR demonstrated significant subjective improvements in PROs and low rates of complications requiring reoperation. At minimum twelve-month follow-up the BPTB cohort had higher mental health scores.