No increased complication rate with the use of soft tissue quadriceps tendon autograft for primary ACL reconstruction – a systematic review - 17/07/24

Doi : 10.1016/j.otsr.2024.103926

Mohamed A. Khalefa ^a,^b,⁎ , Randeep S. Aujla ^c, Nadim Aslam ^a, Tarek Boutefnouchet ^d, Peter D’Alessandro ^e,^f, Peter B. MacDonald ^g, Shahbaz S. Malik ^a
^a Worcestershire Acute Hospitals NHS Trust, Sky Level 3, Charles Hastings Way, Worcester WR5 1DD, United Kingdom
^b Cairo University Hospitals, Cairo, Egypt
^c University Hospitals of Leicester, Leicester, United Kingdom
^d University Hospitals Birmingham, Birmingham, United Kingdom
^e Orthopaedic Research Foundation of Westren Australia, Perth, Australia
^f School of Surgery, University of Westren Australia, Perth, Australia
^g Pan Am Clinic, Winnipeg, Manitoba, Canada

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 17 July 2024

Abstract

Background

The autograft of choice for anterior cruciate ligament reconstruction (ACLR) remains debateable. Recently there has been increased popularity of soft tissue quadriceps tendon (s-QT) autograft due to less donor site morbidity, reduced anterior knee pain and comparable re-operation and complication rates. The aim of this review was to analyse functional outcomes of primary ACLR using s-QT in adult population without the bone plug and to report its complication profile against other autografts.

Patient and methods

This systematic review was performed in accordance with PRISMA guidelines and a review of literature was conducted on four online databases (Medline, EMBASE, Cochrane and Google Scholar). Clinical studies reporting on patients undergoing primary ACLR with s-QT autograft or in comparison to BPTB or HS autografts with a minimum of 6 months follow-up were included. The studies were inclusive of only all soft tissue QT autograft regardless of the implants or fixation method used. Critical appraisal of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) tool.

Results

Fourteen studies were eligible. There were three randomised control studies (RCT) and 11 non-randomised comparative studies with 1543 patients who underwent ACLR. 682 underwent s-QT, 498 had hamstring tendon (HT) and 174 had bone-patellar tendon-bone (BPTB). 60% (n = 930) were males and mean follow up was 23.6 months (6–65). Eight studies reported post-operative patient reported outcome measures (PROMs). The mean International Knee Documentation Committee (IKDC) score was 91.5 ± 15.1 whereas mean Lysholm score was 90 ± 3.9. Five studies reported on laxity with mean anterior tibial translation (ATT) of 1.28 ± 1.09 mm. Overall complication rate of s-QT ACLR was 6% with 3% graft failure, 0.52% arthrofibrosis, 0.2% infection, 0.75% revision ACLR. There was no significant difference in functional outcome scores, knee stability and range of motion (ROM) between s-QT, HT and BPTB.

Conclusion

s-QT for ACLR has a comparable functional outcome, laxity, failure and with overall graft failure rate of 3%.

Level of evidence

III; Systematic review and meta-analysis.

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Keywords : Anterior cruciate ligament reconstruction, ACLR, Soft tissue quadriceps tendon autograft, Quadriceps tendon, Hamstring autograft, Bone patella tendon bone autograft.