Summary

Quadricepstendon grafts reduce donor site morbidity for anterior cruciate ligament reconstruction

Abstract

Background

Anterior Cruciate Ligament reconstruction (ACLR) with quadricepstendon graft (QTB) has recently attracted increasing interest. The reasons for this are good donorsite morbidity profile, good biomechanical properties of the thick tendon part of the graft and the possibility for bone block fixation. Hamstring graft is presently the most used graft type for ACLR. It is unknown if QTB graft reduce donor site morbidity compared to hamstring graft and whether knee stability and function are similar to ACLR with hamstring graft.
The purpose of this study was to compare donorsite morbidity, clinical outcome and muscles function in patients with ACLR using QTB or hamstring graft in a prospective randomized study. We hypothesized reduced donorsite morbidity for QTB grafts compared to hamstring grafts.

Methods

From 2013-15, a total of 99 patients were included in the present study. Inclusion criteria were isolated ACL injuries in adults. 50 patients were randomized to QTB grafts and 49 to hamstring grafts. Antero-posterior knee laxity measured with a KT-1000 arthrometer. Patient evaluated outcome was performed by KOOS, subjective IKDC and Tegner activity scores. Donor site morbidity was evaluated by the validated ‘‘Donor-site-Related Functional Problems following ACL reconstruction score and a detailed questionnaire. Muscle function was evaluated by isokinetic testing.

Results

Donor site symptoms were present in 30 % of patient in the QTB group and 52 % of patients in the hamstring group (p< 0.05). The donor site morbidity score was 82 and 74 for the two graft types (p< 0.05). At one-year follow-up there was no difference between the two groups regarding subjective patient outcome, knee function and objective knee laxity and reoperations. QTB graft reduced only knee extensor muscle function whereas ST graft reduced both knee extensor and flexor function.

Conclusions

The use of the QT graft results in reduced donor site morbidity and muscle function impairment compared to hamstring grafts and has similar subjective and knee stability outcome. The QTB graft could be a better graft choice for ACLR than hamstring grafts.