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Lower donor-site morbidity using QT autografts for ACL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Comparing scar cosmesis and regional hypoesthesia at the incision site between quadriceps tendon (QT), bone–patellar tendon–bone (BPTB), and hamstring tendon (HT) for anterior cruciate ligament (ACL) reconstruction.

Methods

Ninety patients undergoing ACL reconstruction with QT, HT or BPTB were evaluated at 1-year post-op. Scar cosmesis was assessed using the patient and observer scar assessment scale (POSAS) and length of the incision. Sensory outcome was analyzed by calculating the area of hypoesthesia around the scar. The classical ACL reconstruction functional follow-up was measured using the Lysholm score and KOOS.

Results

Concerning QT versus BPTB group, QT patients have a significantly lower mean POSAS (24.8 ± 6.3 vs. 39.6 ± 5.8; p < 0.0001), shorter mean incision (2.8 ± 0.4 cm vs. 6.4 ± 1.3 cm; p < 0.0001), lower extent of hypoesthesia (8.7 ± 5.1 cm2 vs. 88.2 ± 57 cm2; p < 0.0001), and better Lysholm score (90.1 ± 10.1 vs. 82.6 ± 13.5; n.s.). No significant difference was seen in KOOS (90.7 ± 7.2 vs. 88.4 ± 7.0; n.s.). Concerning QT versus HT group, no significant difference was found regarding mean POSAS score (24.8 ± 6.3 vs. 31.8 ± 6.2; n.s.), mean length of the incision (2.8 ± 0.4 cm vs. 2.5 ± 0.6 cm; n.s.), KOOS (90.7 ± 7.2 vs. 89.8 ± 8.2; n.s.) and mean Lysholm score (90.1 ± 10.1 vs. 87.8 ± 0.6; n.s.). The mean measured area of hypoesthesia was significantly higher in the HT group (70.3 ± 77.1 cm2 vs. 8.7 ± 5.1 cm2; p < 0.0001).

Conclusion

Quadriceps tendon harvesting technique has the safest incision by causing less sensory loss compared to BPTB and HT. It also has the advantage of a short incision with more cosmetic scar compared to BPTB, with no difference compared to HT. However, no significant difference in terms of functional outcome was shown between the three autografts. These findings provide surgeons evidence about their clinical practice and help with graft choice decisions.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France

    Dany Mouarbes, Enrique Peque & Etienne Cavaignac

  2. Department of Orthopedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier, France

    Louis Dagneaux

  3. Department of Orthopedic Surgery and Traumatology, Saint Marguerite University Hospital, Marseille, France

    Matthieu Olivier

  4. Department of Orthopaedic Surgery, University Hospital of Nice, Nice, France

    Vincent Lavoue

  5. Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-University of Toulouse III, Toulouse University Hospital, Toulouse, France

    Emilie Berard

  6. Department of Orthopedic Surgery, Hopital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, 3105, Toulouse, France

    Etienne Cavaignac

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  1. Dany Mouarbes
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  2. Louis Dagneaux
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Correspondence to Etienne Cavaignac.

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Mouarbes, D., Dagneaux, L., Olivier, M. et al. Lower donor-site morbidity using QT autografts for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 28, 2558–2566 (2020). https://doi.org/10.1007/s00167-020-05873-1

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