Skip to main content

Advertisement

SpringerLink
Log in

Anterior cruciate ligament reconstruction with all-soft tissue quadriceps tendon versus quadriceps tendon with bone block

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate whether there was a difference in clinical outcomes between patients who underwent primary ACL reconstruction (ACLR) with all-soft tissue quadriceps tendon (sQT) autograft versus QT with bone block (bQT).

Methods

A retrospective cohort study of 708 patients who underwent QT ACLR was conducted. Primary ACLR patients with at least 1 year of follow-up were identified and those who received sQT were compared to those who received bQT. Data collection entailed patient demographics, surgical variables, patient reported outcomes (PROs), knee stability testing, and complications. The primary outcome of interest was International Knee Documentation Committee (IKDC) score, reported as mean score, pre- and postoperative difference, and number who met minimum clinically important difference (MCID). Secondary outcomes included Lachman and pivot shift grade, other patient reported outcomes (PROs), complication rates, and return to sport (RTS).

Results

A total of 195 patients (147 sQT, 48 bQT) who underwent primary QT ACLR met criteria for analysis, with mean follow-up of 17.0 ± 7.9 months. No difference was detected between cohorts with respect to postoperative IKDC score (sQT: n = 120, 81.0 ± 18.9, bQT: n = 10, 80.9 ± 20.4, n.s.), proportion of patients who met MCID (sQT: 68/78 [87%], bQT: 6/7 [86%], n.s.), or results of stability testing. In the sQT cohort, 86% (106/123) of athletes achieved full RTS, compared to 85% (34/40) in the bQT cohort (n.s.). Time to RTS was less than a year in both cohorts (sQT: 10.5 ± 3.8 months [n = 106], bQT: 11.1 ± 3.9 months [n = 31], n.s.). Graft rupture occurred in 7 (5%) sQT patients and 3 (6%) bQT patients (n.s.), and all clinical failures were due to graft rupture (n.s.). No differences were detected for rates of postoperative complications.

Conclusion

No differences in clinical outcomes were detected between patients who underwent primary ACLR with sQT autograft versus bQT autograft. Currently, the decision to employ sQT or bQT is largely determined by surgeon preference. This study demonstrates excellent outcomes with both preparations and supports the use of either graft type at the discretion of the treating surgeon.

Level of evidence

III

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The dataset used and/or analyzed during the current study is available from the corresponding author on reasonable request.

References

  1. Afana HB, Nau T (2021) Physeal-sparing anterior cruciate ligament reconstruction for skeletally immature patients: all-epiphyseal technique using quadricep tendon autograft. Case Rep Orthop 13(2021):5519822

    Google Scholar 

  2. Ajrawat P, Dwyer T, Whelan D, Theodoropoulos J, Murnaghan L, Bhargava M, Ogilvie-Harris D, Chahal J (2021) A comparison of quadriceps tendon autograft with bone-patellar tendon-bone autograft and hamstring tendon autograft for primary anterior cruciate ligament reconstruction: a systematic review and quantitative synthesis. Clin J Sport Med 31(4):392–399

    Article  PubMed  Google Scholar 

  3. Arakgi ME, Burkhart TA, Hoshino T, Degen R, Getgood A (2022) Biomechanical comparison of three suspensory techniques for all soft tissue central quadriceps tendon graft fixation. Arthrosc Sports Med Rehabil 4(3):e843–e851

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48(21):1543–1552

    Article  PubMed  Google Scholar 

  5. Arnold MP, Calcei JG, Vogel N, Magnussen RA, Clatworthy M, Spalding T, Campbell JD, Bergfeld JA, Sherman SL (2021) ACL study group ACL study group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee Surg Sports Traumatol Arthrosc 29(11):3871–3876

    Article  PubMed  Google Scholar 

  6. Castile RM, Jenkins MJ, Lake SP, Brophy RH (2020) Microstructural and mechanical properties of grafts commonly used for cruciate ligament reconstruction. J Bone Joint Surg Am 102(22):1948–1955

    Article  PubMed  Google Scholar 

  7. Crum RJ, Kay J, Lesniak BP, Getgood A, Musahl V, de Sa D (2021) Bone versus all soft tissue quadriceps tendon autografts for anterior cruciate ligament reconstruction: a systematic review. Arthroscopy 37(3):1040–1052

    Article  PubMed  Google Scholar 

  8. de Mees TTCR, Reijman M, Waarsing JH, Meuffels DE (2022) Posteriorly positioned femoral grafts decrease long-term failure in anterior cruciate ligament reconstruction, femoral and tibial graft positions did not affect long-term reported outcome. Knee Surg Sports Traumatol Arthrosc 30(6):2003–2013

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ding DY, Chang RN, Allahabadi S, Coughlan MJ, Prentice HA, Maletis GB (2022) Acute and subacute anterior cruciate ligament reconstructions are associated with a higher risk of revision and reoperation. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-06912-9

    Article  PubMed  Google Scholar 

  10. Fu FH, Rabuck SJ, West RV, Tashman S, Irrgang JJ (2019) Patellar fractures after the harvest of a quadriceps tendon autograft with a bone block: a case series. Orthop J Sports Med 7(3):2325967119829051

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gagliardi AG, Carry PM, Parikh HB, Albright JC (2020) Outcomes of quadriceps tendon with patellar bone block anterior cruciate ligament reconstruction in adolescent patients with a minimum 2 year follow-up. Am J Sports Med 48(1):93–98

    Article  PubMed  Google Scholar 

  12. Geib TM, Shelton WR, Phelps RA, Clark L (2009) Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy 25(12):1408–1414

    Article  PubMed  Google Scholar 

  13. Getgood AMJ, Bryant DM, Litchfield R et al (2020) Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2 year outcomes from the stability study randomized clinical trial. Am J Sports Med 48(2):285–297

    Article  PubMed  Google Scholar 

  14. Glogovac G, Schumaier AP, Grawe BM (2019) Return to sport following revision anterior cruciate ligament reconstruction in athletes: a systematic review. Arthroscopy 35(7):2222–2230

    Article  PubMed  Google Scholar 

  15. Harris JD, Brand JC, Cote MP, Faucett SC, Dhawan A (2017) Research pearls: the significance of statistics and perils of pooling. part 1: clinical versus statistical significance. Arthroscopy 33(6):1102–1112

    Article  PubMed  Google Scholar 

  16. Hart D, Gurney-Dunlop T, Leiter J, Longstaffe R, Eid AS, McRae S, MacDonald P (2022) Biomechanics of hamstring tendon, quadriceps tendon, and bone-patellar tendon-bone grafts for anterior cruciate ligament reconstruction: a cadaveric study. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/s00590-022-03247-6

    Article  PubMed  Google Scholar 

  17. Heffron WM, Hunnicutt JL, Xerogeanes JW, Woolf SK, Slone HS (2019) Systematic review of publications regarding quadriceps tendon autograft use in anterior cruciate ligament reconstruction. Arthrosc Sports Med Rehabil 1(1):e93–e99

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hogan DW, Burch MB, Rund JM, Geeslin DW, Ma R, Gray AF, Chu CR, Ray TE, Pullen WM, Sherman SL (2021) No difference in complication rates or patient-reported outcomes between bone-patella tendon-bone and quadriceps tendon autograft for anterior cruciate ligament reconstruction. Arthrosc Sports Med Rehabil 4(2):e417–e424

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hughes JD, Lynch AD, Smith CN, Musahl V, Irrgang JJ (2022) External fixation increases complications following surgical treatment of multiple ligament knee injuries. Knee Surg Sports Traumatol Arthrosc 30(1):161–166

    Article  PubMed  Google Scholar 

  20. Hurley ET, Calvo-Gurry M, Withers D, Farrington SK, Moran R, Moran CJ (2018) Quadriceps tendon autograft in anterior cruciate ligament reconstruction: a systematic review. Arthroscopy 34(5):1690–1698

    Article  PubMed  Google Scholar 

  21. Kanakamedala AC, de Sa D, Obioha OA, Arakgi ME, Schmidt PB, Lesniak BP, Musahl V (2019) No difference between full thickness and partial thickness quadriceps tendon autografts in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 27(1):105–116

    Article  PubMed  Google Scholar 

  22. Lind M, Nielsen TG, Soerensen OG, Mygind-Klavsen B, Faunø P (2020) Quadriceps tendon grafts does not cause patients to have inferior subjective outcome after anterior cruciate ligament (ACL) reconstruction than do hamstring grafts: a 2-year prospective randomised controlled trial. Br J Sports Med 54(3):183–187

    Article  PubMed  Google Scholar 

  23. Malige A, Baghdadi S, Hast MW, Schmidt EC, Shea KG, Ganley TJ (2022) Biomechanical properties of common graft choices for anterior cruciate ligament reconstruction: a systematic review. Clin Biomech (Bristol, Avon) 95:105636

    Article  PubMed  Google Scholar 

  24. Malinowski K, Paszkowski J, Mostowy M, Góralczyk A, LaPrade RF, Hermanowicz K (2021) Quadriceps tendon-bone full-thickness autograft: reproducible and easy harvesting technique using simple surgical tools. Arthrosc Tech 10(4):e1165–e1172

    Article  PubMed  PubMed Central  Google Scholar 

  25. Martin-Alguacil JL, Arroyo-Morales M, Martin-Gómez JL, Lozano-Lozano M, Galiano-Castillo N, Cantarero-Villanueva I (2019) Comparison of knee sonography and pressure pain threshold after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players. Acta Orthop Traumatol Turc 53(4):260–265

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mayr HO, Bruder S, Hube R, Bernstein A, Suedkamp NP, Stoehr A (2018) Single-bundle versus double-bundle anterior cruciate ligament reconstruction-5 year results. Arthroscopy 34(9):2647–2653

    Article  PubMed  Google Scholar 

  27. Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E (2019) Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med 47(14):3531–3540

    Article  PubMed  Google Scholar 

  28. Muller B, Yabroudi MA, Lynch A, Lai CL, van Dijk CN, Fu FH, Irrgang JJ (2016) Defining thresholds for the patient acceptable symptom state for the IKDC subjective knee form and KOOS for patients who underwent ACL reconstruction. Am J Sports Med 44(11):2820–2826

    Article  PubMed  Google Scholar 

  29. Musahl V, Karlsson J (2019) Anterior cruciate ligament tear. N Engl J Med 380(24):2341–2348

    Article  PubMed  Google Scholar 

  30. Nwachukwu BU, Sullivan SW, Rauck RC, James EW, Burger JA, Altchek DW, Allen AA, Williams RJ 3rd (2021) HSS ACL registry group patient-reported outcomes and factors associated with achieving the minimal clinically important difference after acl reconstruction: results at a mean 7.7 year follow-up. JB JS Open Access. 6(4):e2100056

    Google Scholar 

  31. Ollivier M, Cognault J, Pailhé R, Bayle-Iniguez X, Cavaignac E, Murgier J (2021) Minimally invasive harvesting of the quadriceps tendon: technical note. Orthop Traumatol Surg Res 107(2):102819

    Article  PubMed  Google Scholar 

  32. Perez JR, Emerson CP, Barrera CM, Greif DN, Cade WH 2nd, Kaplan LD, Baraga MG (2019) Patient-reported knee outcome scores with soft tissue quadriceps tendon autograft are similar to bone-patellar tendon-bone autograft at minimum 2 year follow-up: a retrospective single-center cohort study in primary anterior cruciate ligament reconstruction surgery. Orthop J Sports Med 7(12):2325967119890063

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, Stuart MJ, Krych AJ (2016) Incidence of anterior cruciate ligament tears and reconstruction: a 21 year population-based study. Am J Sports Med 44(6):1502–1507

    Article  PubMed  Google Scholar 

  34. Sheean AJ, Musahl V, Slone HS, Xerogeanes JW, Milinkovic D, Fink C, Hoser C (2018) International quadriceps tendon interest group quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med 52(11):698–701

    Article  PubMed  Google Scholar 

  35. Slone HS, Ashford WB, Xerogeanes JW (2016) Minimally invasive quadriceps tendon harvest and graft preparation for all-inside anterior cruciate ligament reconstruction. Arthrosc Tech 5(5):e1049–e1056

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sprowls GR, Robin BN (2018) The quad link technique for an all-soft-tissue quadriceps graft in minimally invasive, all-inside anterior cruciate ligament reconstruction. Arthrosc Tech 7(8):e845–e852

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tan TK, Subramaniam AG, Ebert JR, Radic R (2021) Quadriceps tendon versus hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. https://doi.org/10.1177/03635465211033995

    Article  PubMed  PubMed Central  Google Scholar 

  38. Todor A, Caterev S, Nistor DV, Khallouki Y (2016) Free bone plug quadriceps tendon harvest and suspensory button attachment for anterior cruciate ligament reconstruction. Arthrosc Tech 5(3):e541–e544

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wright RW, Huston LJ, Haas AK et al (2019) Predictors of patient-reported outcomes at 2 years after revision anterior cruciate ligament reconstruction. Am J Sports Med 47(10):2394–2401

    Article  PubMed  Google Scholar 

Download references

Funding

There was no external source of funding for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Ehab M. Nazzal, Nicholas P. Drain, Zachary J. Herman, Clair Smith, Bryson P. Lesniak, Volker Musahl & Jonathan D. Hughes

  2. University of Pittsburgh School of Medicine, 3200 S Water Street, PittsburghPittsburgh, PA, 15203, USA

    Joshua C. Setliff & Asher B. Mirvish

  3. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Jonathan D. Hughes

Authors
  1. Joshua C. Setliff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ehab M. Nazzal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas P. Drain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zachary J. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Asher B. Mirvish
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Clair Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bryson P. Lesniak
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Volker Musahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jonathan D. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua C. Setliff.

Ethics declarations

Conflict of interest

The authors of this study confirm that they have no conflicts of interest related to this study.

Ethical approval

#STUDY19030196.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Setliff, J.C., Nazzal, E.M., Drain, N.P. et al. Anterior cruciate ligament reconstruction with all-soft tissue quadriceps tendon versus quadriceps tendon with bone block. Knee Surg Sports Traumatol Arthrosc 31, 2844–2851 (2023). https://doi.org/10.1007/s00167-022-07254-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-022-07254-2

Keywords

Search

Navigation