2015 ISAKOS Biennial Congress ePoster #1255

Outcome of Anatomic ACL Reconstruction - Single Bundle Quadriceps Versus Double Bundle Hamstring Tendon Graft

Joon Kyu Lee, MD, PhD, Anyang KOREA, REPUBLIC OF
Sahnghoon Lee, MD, PhD, Seoul KOREA, REPUBLIC OF
Hyuk-Soo Han, MD, PhD, Seoul KOREA, REPUBLIC OF
Chong Bum Chang, MD, PhD, Seongnam-Si, Gyeonggi-do KOREA, REPUBLIC OF
Yong-Seuk Lee, MD, PhD, Prof., Seongnam, Kyung-gi KOREA, REPUBLIC OF
Sang Cheol Seong, MD, PhD, mapo-gu, Seoul city KOREA, REPUBLIC OF
Myung Chul Lee, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF

Seoul National University Hospital, Seoul, KOREA

FDA Status Cleared

Summary: ACL reconstruction with single bundle quadriceps tendon autograft produced similar functional results and more favorable muscle strength recovery compared with the double bundle hamstring tendon autograft.




The choice of the graft is an important factor to an overall outcome of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the clinical and functional outcomes of ACL reconstructions using the single bundle quadriceps tendon and the double bundle hamstring tendon autografts. Methods: Forty-eight patients who underwent unilateral ACL reconstruction using double bundle hamstring tendon autograft were selected and matched for age, body mass index and gender with 48 patients who underwent ACL reconstruction using quadriceps tendon autograft. Only the patients who had at least 24-month follow-up were included. All patients were followed up for more than 2 years (range, 24 to 61 months). Outcome evaluations included manual laxity test, KT-2000 arthrometry, IKDC subjective evaluation, Tegner activity score, modified Lysholm score, questionnaire regarding anterior knee pain and Cybex II isokinetic testing. Statistical analysis: Comparisons between the groups were performed using the Student t test for the continuous normal distribution data and a Mann-Whitney U test for the ordinal categorical and non-normal distribution data. Comparisons within the groups between the preoperative and postoperative data were performed using a paired t-test for the continuous normal distribution data and a Wilcoxon signed-rank test for the ordinal categorical and non-normal distribution data. A Pearson chi-square test was used for the nominal categorical data. The level of significance was set at p=0.05. Results: Anterior drawer, Lachman and pivot shift tests were grade 0 or 1 in over 95% of patients in both groups after surgery. There were no significant differences between the groups (all p>0.05). The maximum side-to-side differences in KT-2000 arthrometry improved to 2.1mm in quadriceps tendon group and 2.0mm in hamstring tendon group (p=0.65). Modified Lysholm score improved to 92.1 and 88.4 (p=0.30) and IKDC subjective evaluation improved to 80.2 and 77.9 (p=0.37), respectively. Tegner activity score was 4.7 and 4.6 (p=0.80) at the final follow up, respectively. Questionnaires revealed no differences between the two groups on postoperative anterior knee pain during strenuous work, climbing stairs, long period sitting, kneeling and normal daily activities (all p>0.05). Recovered extensor muscle strengths measured by Cybex II isokinetic testing were not different between the two groups (81.0% vs. 82.9% at 60°/s (p=0.65), 83.8% vs. 85.1% at 180°/s (p=0.81)). However, the flexor muscle strengths recovery was better in quadriceps tendon group (92.2% vs. 86.6% at 60°/s (p=0.22), 99.5% vs. 87.1% at 180°/s (p=0.01)). Discussion and Conclusion: We could achieve similar knee stability, functional results and postoperative anterior knee pain in ACL reconstruction using single bundle quadriceps tendon autograft when compared with the double bundle hamstring autograft. Additionally, better flexor muscle strength recovery was found in quadriceps tendon autograft group, indicating a potential advantage of quadriceps tendon autograft in ACL reconstruction.