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Comparison of Clinical Outcomes between a Bone-Patellar Tendon-Bone and Quadriceps Tendon-Bone Autografts in Anatomic Rectangular Tunnel Anterior Cruciate Ligament Reconstruction

2023 Congress Paper Abstracts
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Comparison of Clinical Outcomes between a Bone-Patellar Tendon-Bone and Quadriceps Tendon-Bone Autografts in Anatomic Rectangular Tunnel Anterior Cruciate Ligament Reconstruction

Kazunori Shimomura, MD, PhD, Prof., JAPAN Yasukazu Yonetani, MD, PhD, JAPAN Ayaka Tanaka, MD, JAPAN Akira Tsujii, MD, PhD, JAPAN Masayuki Hamada, MD, JAPAN

Department of Sports Orthopaedics, Hoshigaoka Medical Center, Hirakata, Osaka, JAPAN


2023 Congress   ePoster Presentation   2023 Congress   rating (1)

 

Anatomic Location

Anatomic Structure

Treatment / Technique

Ligaments

ACL

Patient Populations


Summary: In the anatomic rectangular tunnel ACLR, clinical outcomes, the value of KT-1000, and secondary ACL injury rates were equivalent in the BTB and QTB groups, but the frequency of anterior knee pain was significantly lower in the QTB group, suggesting that QTB could be a useful graft for ACLR.


Anatomic rectangular tunnel anterior cruciate ligament reconstruction (ART-ACLR) can mimic the fiber arrangement of the native ACL and restore normal knee biomechanics, compared to the conventional round tunnel ACLR. The ART-ACLR using a bone–patellar tendon–bone (BTB) graft could provide satisfactory clinical outcomes, while there remain some issues to be solved such as secondary ACL injury and postoperative anterior knee pain (AKP). Recently, a quadriceps tendon-bone (QTB) graft has been paid attention to as an alternative graft choice, because such a graft has higher tensile strength and is thicker than BTB. Thus, it is possible that the QTB graft would reduce the rate of secondary ACL injury and AKP. In this study, we compared the clinical outcomes after ART-ACLR between BTB and QTB.

101 patients underwent primary ART-ACLR with either BTB (N=52) or QTB (N=49).
Each group were matched on age, sex, body mass index, and additional surgeries including meniscectomy, meniscal repair and chondral drilling; there were no statistically significant differences between both groups. All patients had a minimum follow-up of 1 year and up to 2 years postoperatively. Outcome evaluations included International Knee Documentation Committee (IKDC) subjective evaluation, side-to-side differences with KT-1000 knee arthrometer, secondary ACL injury rate and the frequency of AKP.

IKDC subjective score improved from preoperative (BTB: 55.4±15.2, QTB: 57.4±13.8) to 1 year (BTB: 82.4±11.0, QTB: 85.4±10.9) and 2 years (BTB: 86.8±10.0, QTB: 85.4±11.4). There were no significant differences between BTB and QTB in each time point. In the value of KT-1000, there were also no significant differences between both groups (BTB: 0.36±0.99 mm, QTB: 0.37±1.36 mm). The secondary ACL injury rates were 9.6% on the ipsilateral side and 1.9% on the contralateral side in the BTB group, whereas 6.1% on the ipsilateral side and 2.0% on the contralateral side in the QTB group, with no significant difference between both groups. The frequency of AKP was 23.1% in the BTB group and 4.1% in the QTB group, with significance (P=0.006).

In the ART-ACLR, clinical outcomes, the value of KT-1000, and secondary ACL injury rates were equivalent in the BTB and QTB groups. On the other hand, the frequency of AKP was significantly lower in the QTB group, suggesting that QTB could be a useful graft for ACLR.


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