comparative study of two ACL reconstructions grafts performed with the same technique with 3.6 years follow-up
The quadriceps tendon (QT) autograft is known as an effective graft for ACL reconstruction and shows a similar functional outcome as bone-patellar tendon-bone (BPTB) in RCT with a lesser incidence of complications. Up to now, only two studies have compared QT to hamstring tendon (HT) autograft.The results of one of these studies are inconsistent with other published results and with our day-to-day observations, while the results of the other study were impacted by confounding factors
Our hypothesis is that the functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.
Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, KOOS, Tegner, subjective IKDC), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne and Trumper score) and isokinetic strength. Descriptive statistics are presented for these variables using Student’s t-test.
Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years. There were four reoperations in the QT group (including one ACL revision) and three in the HT group (including two ACL revisions) (P > 0.05). The Lysholm (89 ± 6.9 vs. 81 ± 5.3), KOOS Symptoms (90 ± 11.2 vs. 81 ± 10.3) and KOOS Sport (82 ± 11.3 vs. 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements (P < 0.005). The negative Lachman component was lower in the QT group than the HT group (90% vs. 46 %, P < 0.005). The Shelbourne and Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength.
The use of a QT graft in ACL reconstruction leads to better functional outcomes than the use of an HT graft, without impacting morbidity. Our study reveals differences in outcomes that every surgeon should know, showing the ins and outs of ACL reconstruction with the QT and comparing the outcomes with those expected following an HT procedure.
QT is a suitable alternative for ACL reconstruction.