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Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the functional and graft survivorship outcomes of the three most common autograft options for primary anterior cruciate ligament reconstruction (ACLR)—hamstring tendon (HT), bone-patella-tendon-bone (BPTB), and quadriceps tendon (QT).

Methods

Patients captured by the New Zealand ACL registry who underwent a primary ACLR from 2014 to 2020 were considered for the study. Patients with associated knee injury (including meniscus, chondral, osseous, and additional ligamentous injury) and previous knee surgery were excluded. Comparison was made between HT, BPTB, and QT autografts with respect to Marx and KOOS (Knee Osteoarthritis Outcome Score) scores at minimum 2 years follow-up. In addition, graft survivorship was evaluated by comparing all-cause revision per 100 graft years and revision-free proportion at 2 years post-surgery.

Results

2,582 patients (1,921 HT, 558 BPTB, 107 QT) were included in the study. Differences in adjusted functional outcomes between HT and BPTB were found at 12 months (mean Marx; HT 6.2; BPTB 7.1; P < 0.001) (mean KOOS Sport and Recreation; HT 75.1; BPTB 70.5; n.s.) and 24 months (mean KOOS Sports and Recreation; HT 79.2; BPTB 73.9; P < 0.001). QT was comparable to HT and BPTB in all functional scores at 12 months and 2 years. No statistically significant differences were found in revision rate between all three autograft groups up to 2 years post-surgery (revision rate per 100 graft years; HT 1.05; BPTB 0.80; QT 1.68; n.s. HT vs. BPTB; n.s. HT vs. QT; n.s. QT vs. BPTB).

Conclusions

QT was found to be comparable to both HT and BPTB in all functional scores and revision rates up to 2 years post-surgery.

Level of evidence

Level III.

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Data availability

The data that support the findings of this study are available from the New Zealand ACL Registry but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the New Zealand ACL Registry.

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Funding

Northland Orthopaedic Charitable Research Trust

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Authors and Affiliations

  1. Whangarei Hospital, Northland District Health Board, Maunu Road, Private Bag 9742, Whangarei, 0148, New Zealand

    Yushy Zhou, Atua Fuimaono-Asafo, Michael van Niekerk & Marc Hirner

  2. Department of Psychological Medicine, University of Otago, Otago, New Zealand

    Chris Frampton

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Correspondence to Yushy Zhou.

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Ethical approval

This study was approved to be performed by the New Zealand ACL Registry on 4 February 2021. Ethics approval was not required.

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Zhou, Y., Fuimaono-Asafo, A., Frampton, C. et al. Quadriceps tendon autograft is comparable to hamstring tendon and bone-patella-tendon-bone up to 2 years after isolated primary anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 31, 3268–3276 (2023). https://doi.org/10.1007/s00167-023-07370-7

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