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A prospective randomized controlled study of hamstring and bone-free quadriceps tendons autografts in arthroscopic ACL reconstruction

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Anterior cruciate ligament (ACL) reconstruction is one of the most common surgical procedures worldwide. However, the ideal graft source is still debatable. This study compared hamstring (HT) and bone-free quadriceps (QT) tendon autografts in terms of muscle strength and patient-reported outcomes.

Methods

Between June 2018 and December 2019, 46 patients were enrolled in the study and randomly assigned to one of two groups for the ACL reconstruction surgery—the HT autograft group or the QT autograft group. An experienced examiner performed preoperative and postoperative examinations. The HUMAC NORM isokinetic machine (Computer Sports Medicine International-CSMI, 2004) was used to assess flexor and extensor thigh muscle strength. Both groups received the same surgical technique and fixation method. All patients were examined after three, six, nine, and 12 months. The final evaluations were performed at the 24-month follow-up. Patients’ scores on the International Knee Documentation Committee (IKDC) evaluation form and the Lysholm Knee Scoring Scale were used to evaluate patient-reported outcomes. The two groups were also compared in terms of postoperative complications and activity levels.

Results

The difference between preoperative and postoperative knee flexor peak torques (FPT) was lower in the QT group than in the HT group. The average difference between preoperative and postoperative knee extensor peak torque (EPT) was higher in the QT group than in the HT group. As a result, the HT group had a lower postoperative H/Q ratio (flexor strength normalized to body mass divided by extensor strength normalized to body mass) than the QT group (p < 0.001). The mean IKDC scores for the HT and QT groups were 90.13 ± 6.99 and 87.12 ± 6.61, respectively. The scores of the two groups postoperatively were close, and both groups showed significant improvement. The average graft size in the QT group was significantly greater than that in the HT group. Saphenous nerve palsy was the most common complication in the HT group (22%). Thigh hematomas were observed in two patients in the QT group and required urgent intervention (12%).

Conclusion

After ACL reconstruction, we found a significant decrease in strength at the donor sites in both techniques, with similar patient-reported measures and stability outcomes. The H/Q strength ratio was higher in the QT group postoperatively, which may have a protective effect on the reconstructed ligament.

Level of Evidence I It is a randomized controlled trial.

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Abbreviations

ANOVA:

Analyses of the variance

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

BW:

Body weight

Cm:

Centimeters

CSMI:

Computer Sports Medicine International

EPT:

Extensor peak torques

FPT:

Flexor peak torques

HT:

Hamstring tendon

H/Q:

Hamstring/quadriceps

IKDC:

International Knee Documentation Committee

IPBSN:

Infrapatellar branch of the saphenous nerve

KOOS:

The Knee Injury and Osteoarthritis Outcome Score

Mm:

Millimeters

Nm:

Newton-meters

PROM:

Patient-reported outcome measures

PT:

Patellar tendon

QT:

Quadriceps tendon

SD:

Standard deviation

TC:

Thigh circumference

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Acknowledgements

We thank Turker Sahinkaya for his help with the strength measurement tests.

Funding

None.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Istanbul Bakirkoy Training and Research Hospital, Tevfik Saglam St. Number 11, 34147, Bakirkoy/Istanbul, Turkey

    Neset Tang

  2. Department of Orthopedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey

    Murat Eren & Yusuf Ozturkmen

  3. Joondalup Orthopaedic Group, Joondalup, WA, Australia

    Tahsin Gurpinar

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  1. Neset Tang
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  2. Murat Eren
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  4. Yusuf Ozturkmen
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Contributions

NT Contribution: study design, manuscript preparation; ME Contribution: performed measurements, study design; TG Contribution: critical revision; YO Contribution: manuscript preparation.

Corresponding author

Correspondence to Neset Tang.

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All 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 by the ethical standards of the institutional review board (IRB) of the Istanbul Training And Research Hospital with decision number 1335, at 07-06-2018 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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Tang, N., Eren, M., Gurpinar, T. et al. A prospective randomized controlled study of hamstring and bone-free quadriceps tendons autografts in arthroscopic ACL reconstruction. Eur J Orthop Surg Traumatol 34, 293–301 (2024). https://doi.org/10.1007/s00590-023-03636-5

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