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There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study

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

Abstract

Purpose

Graft choice for anterior cruciate ligament (ACL) reconstruction is crucial, however the optimal graft source remains a topic of controversy. The purpose of this study is to compare subjective and functional patient-reported outcomes (PRO) after single-bundle ACL reconstruction using quadriceps tendon (QT) or hamstring tendon (HT) autografts for single-bundle ACL reconstruction. We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft.

Methods

All data were extracted from a prospectively collected ACL registry. A total of 80 patients with at least 2-year follow-up were included in this study. A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex, age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts. Subjective and functional PRO scores including Lysholm score, Tegner activity level and visual analogue scale for pain were obtained at 6, 12 and 24 months after index surgery.

Results

No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain. 24 months post-surgery the mean Tegner activity score of the HT group was significantly (p = 0.04) lower compared to the pre-injury status. At final follow-up, 27 patients (67.5%) in the QT group and 32 patients (80.0%) in the HT returned to their pre-injury activity level (n.s.). A total of 37 patients (92.5%) of the QT cohort and 35 patients (87.5%) of the HT cohort reported “good” or “excellent” results according to the Lysholm score (n.s.). “No pain” or “slight pain” during severe exertion was reported by 33 patients (82.5%) with QT autograft and 28 patients (82.4%) with HT autograft (n.s.).

Conclusion

There is no significant difference between PRO 2 years post-operative using either QT or HT autografts. Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction.

Level of evidence

III.

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Acknowledgements

We thank Filippo Piana for his help within the data acquisition and Kevin Boehm for his help with the manuscript.

Authors’ contribution

AR was involved in the conception or design, acquisition, analysis, interpretation of data, drafting of the manuscript and final approval; GW was involved in the analysis, interpretation of data, drafting of the manuscript, critical revision of the manuscript and final approval; EH was involved in the analysis, interpretation of data, critical revision of the manuscript and final approval; CH was involved in the acquisition, analysis, interpretation of data, critical revision of the manuscript and final approval; MH was involved in the analysis, interpretation of data, critical revision of the manuscript and final approval; PG was involved in the conception or design, critical revision of the manuscript and final approval; CH was involved in the conception or design, critical revision of the manuscript and final approval; CF was involved in the conception or design, critical revision of the manuscript and final approval.

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Correspondence to Peter Gföller.

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Conflict of interest

Christan Fink received royalties from Karl Storz and consultancies from Karl Storz and Medacta. All other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants as well as the used registry were in accordance with the ethical standards of the institutional review board (IRB) of the Medical University of Innsbruck (AN2015-0050346/4.28) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all patients included in the study.

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Runer, A., Wierer, G., Herbst, E. et al. There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sports Traumatol Arthrosc 26, 605–614 (2018). https://doi.org/10.1007/s00167-017-4554-2

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