Cavaignac, Am J Sports Med 2017 - Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study with a Mean Follow-Up of 3.6 Years - Article Summary

Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study with a Mean Follow-Up of 3.6 Years

Cavaignac, Menetrey, et al.·Am J Sports Med·2017·204 citations·Retrospective cohort

Background

The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft.

Purpose

Hypothesis: The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.

Methods

Study Design: Cohort study; Level of evidence, 3.

95 patients underwent isolated ACL reconstruction between January 1 and December 31, 2012.
50 underwent ACL reconstruction with the QT and 45 with the HT.
The same surgical technique, fixation method, and postoperative protocol were used in both groups.
The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength.
Descriptive statistics are presented for these variables using the Student t test.

Results

86 patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years.
There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) (P > .05).
The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group.
In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements (P < .005).
The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005).
There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052).
The Shelbourne-Trumper score was the same in both groups.
There was no difference between groups in terms of isokinetic strength.

Conclusions

The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.

Supplemental

Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study with a Mean Follow-Up of 3.6 Years.

Cavaignac, Menetrey, et al.Am J Sports Med2017204 citationsRetrospective cohort