2015 ISAKOS Biennial Congress Paper #0

Mid-Term Outcomes of the All-Soft Quadriceps Tendon Versus Hamstring Autograft In Primary Anterior Cruciate Ligament Reconstruction: Comparison With Minimum 5-Year Follow Up

Joseph C. Brinkman, MD, Paradise Valley, AZ UNITED STATES
Sailesh Vardhan Tummala, MD, Phoenix, AZ UNITED STATES
Kade Soren Mcquivey, MD, Phoenix, AZ UNITED STATES
David G Deckey, MD, Phoenix, Arizona UNITED STATES
Jeffrey D. Hassebrock, MD, Boulder, Colorado UNITED STATES
Mayo Clinic Arizona, Scottsdale, AZ, UNITED STATES

FDA Status Cleared

Summary: ACL reconstruction using soft tissue QT autograft demonstrates equivalent clinical outcomes compared to HT autograft at 2 years yet statistically higher patient reported outcomes at 5-years postoperatively.

Abstract:

Purpose

The purpose of this study was to compare the 5-year clinical and functional outcomes
of the soft tissue quadriceps tendon (QT) to those of the hamstring tendon (HT)
autograft

Methods

A retrospective review of patients undergoing ACL reconstruction using either soft
tissue QT or HT autograft with at least 5 years of follow up was conducted. Surgical
technique included anteromedial portal creation for the femoral tunnel and transtibial
technique for the tibia. Graft fixation was achieved with interference screws for the QT
and combination of interference screw and suture button for the HT cohort. The two
groups were compared for differences in outcomes including International Knee
Documentation Committee (IKDC) score, Lysholm score, return to sport, and
complications.

Results

A total of 37 patients with QT autograft and 46 HT autografts were included in the study
with a mean follow up of 69.9 months and 70.9 months, respectively. The QT group
demonstrated a larger graft size on average (9.64mm vs. 7.90mm, p <0.001). The
IKDC and Lysholm scores were not significantly different between the two groups at 2-
years postoperatively. At 5-years postoperatively, the QT group demonstrated
significantly greater IKDC (p 0.018) and Lysholm (p 0.007) scores although the
absolute difference did not meet minimal clinically important difference (MCID)
thresholds. There was no significant difference in the rate of achieving MCID at either 2
or 5 years postoperatively. The two groups demonstrated comparable rates of return to
sport, time to return, and postoperative complications.

Conclusion

ACL reconstruction using soft tissue QT autograft had equivalent clinical outcomes
compared to HT autograft at 2 years and statistically higher patient reported outcomes
at 5-years postoperatively. There was no clinically significant difference found between
the two cohorts. The QT autograft is an effective alternative to HT autograft with noninferior
outcomes to the hamstring autograft at mid-term follow up.