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Quadriceps Tendon Autograft versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction - A Systematic Review & Meta-Analysis
ESSKA Academy. Hurley E. May 11, 2018; 218140; FP45-890
Eoghan T. Hurley
Eoghan T. Hurley
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Abstract
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Objectives: The purpose of this study is to systematically review the current evidence & meta-analyze the results to ascertain if the quadricep-tendon autograft (QT) is a viable option compared to hamstring tendon autograft (HT) in anterior cruciate ligament reconstruction. Our hypothesis was that the current literature would support the use of QT as an alternative to HT in ACL reconstruction.

Methods: Two independent reviewers performed the literature search based on the PRISMA guidelines, with a senior author arbitrating any discrepancies.
MEDLINE, EMBASE and The Cochrane Library databases were used to perform the search. Cohort studies comparing QT with HT were included. Level of evidence (LOE) was evaluated using the Oxford criteria. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3, with a p-value < 0.05 being considered statistically significant.

Results: There were 9 studies (LOE I; 1, LOE II; 3, LOE III; 5) comparing 615 patients with QT to 557 patients with HT, with a mean follow-up time of 24 months. There were no significant difference between the cohorts in terms of age, gender, or concomitant cartilage injuries (p > 0.05). Compared to HT, QT had similar levels of knee stability with no difference in the Lachman test (2.5% vs 5.2%, p = 0.25), the pivot shift test (2.4% vs 4.0%, p = 0.22), or KT arthrometer > 3cm (22.5% vs 31.2%, p = 0.90), but had a lower KT arthrometer 1000 score (1.5mm vs 2.8mm, p = 0.04). Functionally, both grafts had similar functional outcomes in terms of the IKDC score (85.0 vs 82.5, p = 0.49), and Lysholm score (89.7 vs 88.3, p = 0.19). There was no difference in re-rupture rate (0.8% vs 2.4%, p = 0.35).

Conclusions: The current literature suggests QT is a viable alternative to HT in ACL reconstruction, with published literature showing favourable knee stability, functional outcomes, and re-rupture rates compared to BPTB and HT.

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