Quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction has been proposed as an alternative to bone-patellar tendon-bone (BTB) autograft in young, high-demand patients to achieve comparable clinical outcomes while avoiding complications associated with BTB autograft. However, few studies have reported patient satisfaction, rate of return to sport, rate of reinjury, and psychological readiness for return to sport at early-term follow-up.
All patients who underwent ACL reconstruction with QT autograft between January 2018 and February 2020 were identified in a single institution registry and matched to a control group of patients who underwent BTB autograft ACL reconstruction on the basis of age and sex. Patients were contacted at a minimum of 24-months post-surgery to evaluate patient reported outcome measures, patient satisfaction, rate of return to sport, level of sports participation, rate of reinjury, and psychological readiness for return to sport. Psychological readiness was determined using a six-item questionnaire adapted from the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale.
Twenty-seven QT patients (11 men, 16 women) with a mean age of 20.8 years (range 13-44) were compared to 77 BTB patients (41 men, 36 women) with a mean age of 23.9 years (range, 13-45) who responded at an average follow-up of 29.5 months. Patient satisfaction with outcome was high for both groups, with 91% of QT patients versus 83% of BTB patients reporting being very satisfied or somewhat satisfied with results of surgery (P=0.23). There were no significant differences between QT versus BTB patients with respect to mean post-operative PROMIS Pain Interference (42.1 versus 44.2, P=0.18), PROMIS Mobility (58.8 versus 56.6, P=0.16), IKDC (87.9 versus 85.8, P=0.50), Marx Activity Scale (8.8 versus 9.9, P=0.30), or SANE (85.5 versus 83.9, P=0.74) scores. There were 88% of QT patients versus 73% of BTB patients who returned to sports participation (P=0.15) and no statistically significant difference in the number of patients reporting participation at the same level of competition or higher between groups (P=0.21). There were no statistically significant differences in mean ACL-RSI scale scores between QT (75.5 ± 27.9) and BTB (68.9 ± 26.7) patients (P=0.32) or confidence in ability to play sports between QT (83.3 ± 24.0) and BTB (79.6 ± 24.3) patients (P=0.54). There were no graft failures in either group.
Discussion And Conclusion
Satisfaction with outcome was high for both groups. Return to sport rates for QT and BTB patients were similar at early follow-up. There were no differences in psychological readiness for return to sport among QT and BTB patients or in the number of patients returning to the same level of competition or higher. These results suggest comparable functional outcomes between QT and BTB graft types at early-term follow-up.