Is quadriceps tendon autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3.6 years
Author(s):
Cavaignac E. (France)
,
Cavaignac E. (France)
Affiliations:
Duthon Victoria
,
Duthon Victoria
Affiliations:
Tscholl P.
,
Tscholl P.
Affiliations:
Menetrey J.
Menetrey J.
Affiliations:
ESSKA Academy. cavaignac e. 05/09/18; 209454; P06-144 Topic: Sports Related Injuries
Dr. etienne cavaignac
Dr. etienne cavaignac
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Abstract
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Objectives: The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome as bone-patellar tendon-bone (BPTB) in RCT with a lesser incidence of complications. Up to now, only two studies have compared QT to hamstring tendon (HT) autograft. Our hypothesis is that the functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.

Methods: We did a retrospective cohort study. Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, KOOS, Tegner, subjective IKDC), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score) and isokinetic strength. Descriptive statistics are presented for these variables using Student's t-test.

Results: Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were four reoperations in the QT group (including one ACL revision) and three in the HT group (including two ACL revisions) (P > 0.05). The Lysholm (89 ± 6.9 vs. 81 ± 5.3), KOOS Symptoms (90 ± 11.2 vs. 81 ± 10.3) and KOOS Sport (82 ± 11.3 vs. 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements (P < 0.005). The negative Lachman component was higher in the QT group than the HT group (90% vs. 46 %, P < 0.005). There was a trend for the negative pivot shift component to be higher in the QT group than the HT group (90% vs. 64 %, P = 0.052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength.

Conclusions: The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than the use of an HT graft, without impacting morbidity.

Keywords:
ACL reconstruction, Quadriceps tendon, harmstring
Objectives: The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome as bone-patellar tendon-bone (BPTB) in RCT with a lesser incidence of complications. Up to now, only two studies have compared QT to hamstring tendon (HT) autograft. Our hypothesis is that the functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.

Methods: We did a retrospective cohort study. Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, KOOS, Tegner, subjective IKDC), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score) and isokinetic strength. Descriptive statistics are presented for these variables using Student's t-test.

Results: Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were four reoperations in the QT group (including one ACL revision) and three in the HT group (including two ACL revisions) (P > 0.05). The Lysholm (89 ± 6.9 vs. 81 ± 5.3), KOOS Symptoms (90 ± 11.2 vs. 81 ± 10.3) and KOOS Sport (82 ± 11.3 vs. 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements (P < 0.005). The negative Lachman component was higher in the QT group than the HT group (90% vs. 46 %, P < 0.005). There was a trend for the negative pivot shift component to be higher in the QT group than the HT group (90% vs. 64 %, P = 0.052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength.

Conclusions: The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than the use of an HT graft, without impacting morbidity.

Keywords:
ACL reconstruction, Quadriceps tendon, harmstring
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