Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction show comparable clinical, functional, and patient-reported outcome measures, but lower donor-site morbidity compared with hamstring tendon autograft: A matched-pairs study with a mean follow-up of 6.5 years

Abstract

Objectives: To compare clinical and functional outcomes of patients after primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon-(QT-A) and hamstring tendon (HT-A) autograft with a minimum follow-up (FU) of 5 years. Methods: Between 2010 and 2014, all patients undergoing ACLR were recorded in a prospectively administered database. All patients with primary, isolated QT-A ACLR and without any concomitant injuries or high grade of osteoarthritis were extracted from the database and matched to patients treated with HT-A. Re-rupture rates, anterior-posterior (ap) knee laxity, single-leg hop test (SLHT) performance, distal thigh circumference (DTC) and patient-reported outcome measures (PROMs) were recorded. Between group comparisons were performed using chi-square-, independent-samples T-or Mann-Whitney-U tests. Results: 45 QT-A patients were matched to 45 HT-A patients (n 90). The mean FU was 78.9 AE 13.6 months. 18 patients (20.0%/QT-A: N 8, 17.8%; HT-A: n 10, 22.2%; p .60) sustained a graft rupture and 17 subjects (18.9%/QT-A: n 9, 20.0%; HT-A: n 8, 17.8%; p .79) suffered a contralateral ACL injury. In high active patients (Tegner activity level ! 7) rerupture rates increased to 37.5% (HT-A) and 22.2% (QT-A; p .32), respectively. Patients with graft failure did not differ between both groups in terms of mean age at surgery (QT-A: 26.5 AE 11.6 years, HT-A: 23.3 AE 9.5 years, p .63) or graft thickness (mean graft square area: QT-A: 43.6 AE 4.7 mm 2 , HT-A: 48.1 AE 7.9 mm 2 , p .27). No statistical between-group differences were found in ap knee laxity side-to-side (SSD) measurements (QT-A: 1.9 AE 1.2 mm, HT-A: 2.1 AE 1.5 mm; p .60), subjective IKDC-(QT-A: 93.8 AE 6.8, HT-A: 91.2 AE 7.8, p .17), Lysholm-(QT-A 91.9 AE 7.2, HT-A: 91.5 AE 9.7, p .75) or any of the five subscales of the KOOS score (all p > .05). Furthermore, Tegner activity level (QT-A: 6(1.5), HT-A: 6(2), p .62), VAS for pain (QT-A: 0.5 AE 0.9, HT-A: 0.6 AE 1.0, p .64), Shelbourne-Trumper score (QT-A: 96.5 AE 5.6, HT-A: 95.2 AE 8.2, p .50), Patient and Observer Scar -Assessment scale (POSAS) (QT-A: 9.4 AE 3.2, HT-A: 10.7 AE 4.9, p .24), SSD-DTC (QT-A: 0.5 AE 0.5, HT.-A: 0.5 AE 0.6, p .97), return to sports rates (QT-A: 82.1%, HT-A: 86.7%) and SLHT (QT -A: 95.9 AE 3.8%, HT-A: 93.7 AE 7.0%) did not differ between groups. Donor-site morbidity (HT-A n 14, 46.7%; QT-A n 3, 11.5%; p .008) was statistically significantly lower in the QT-A group. Five patients (11.1%) of the HT-group and three patients (6.7%) in the QT-group required revision surgery (p .29). Conclusion: Patient-reported outcome measures, knee laxity, functional testing results and re-rupture rates are similar between patients treated with QT-and HT-autografts. However, patients with QT-autograft have a smaller tibial postoperative scar length and lower postoperative donor-site morbidity. There is a tendency towards higher graft rupture rates in highly active patients treated with HT autograft. Level of evidence: II.

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