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Quadriceps Tendon Autograft versus Bone-Patellar Tendon Autograft in Anterior Cruciate Ligament Reconstruction - A Systematic Review & Meta-Analysis
ESSKA Academy. Hurley E. May 12, 2018; 218118; FP43-891
Eoghan T. Hurley
Eoghan T. Hurley
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Abstract
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Objectives: Quadriceps tendon autograft (QT) is a recognised graft option for anterior cruciate ligament (ACL) reconstruction but its use to date has been mostly reserved for the revision setting. Recently there has been increased interest in the use of QT for primary ACL reconstruction. The purpose of this study is to systematically review the current evidence to ascertain if the quadriceps-tendon autograft is a viable option in anterior cruciate ligament reconstruction and it's results compared to bone-patellar tendon-bone autograft (BPTB). Our hypothesis was that the current literature would support the use of QT as an alternative to BPTB in ACL reconstruction.

Methods: Two independent reviewers performed the literature search of Medline, EMBASE and the Cochrane Libraries based on the PRISMA guidelines, with a senior author arbitrating any discrepancies. Cohort studies comparing QT with BPTB were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3, and a p-value < 0.05 was considered statistically significant.

Results: Six clinical trials were identified with 1092 patients. The baseline demographics of the cohorts were equivocal. QT had lower rates of anterior knee pain (7.1% vs 36.1%, p < 0.00001) and numbness (1.8% vs 47.9%, p < 0.00001) compared to BPTB. Knee stability was similar between both groups, with no difference in the Lachman test (5.3% vs 3.5%, p = 0.31), the pivot shift test (5.5% vs 5.8%, p = 0.53), or KT athrometer > 3cm (20.2% vs 22.2%, p = 0.77). There was also no difference in re-rupture rate (2.1% vs 3.6%, p = 0.35) or IKDC score (86.6 vs 86.7, p = 0.40).

Conclusions: The current literature suggests QT is a viable option in ACL reconstruction, with published literature showing comparable knee stability, functional outcomes, and re-rupture rates compared to BPTB. QT was also shown to have a lower incidence of anterior knee pain, which may be advantageous in certain patient populations.

Keywords:
anterior cruciate ligament, meta-analysis, patellar tendon autograft, quadriceps tendon autograft, systematic review
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