Summary
Patients treated with sQT or bQT report similar postoperative patient-reported outcomes and ACL revision- and contralateral ACL surgery rates.
Abstract
Background
Quadriceps tendon autograft (QT) for anterior cruciate ligament reconstruction (ACLR) is becoming increasingly popular. QT harvesting can be performed with an additional femoral bone block (bQT) or soft tissue only (sQT).
Purpose
To compare patient-reported outcome measurements (PROMs) and reoperation rates in patients treated with bQT or sQT.
Study Design: Cohort study; Level of evidence 3
Methods
All primary ACLRs performed between 2010 and 2021 were prospectively followed at 6, 12, and 24 months postoperative through the recording of subsequent surgeries and patient-administered questionnaires (VAS for pain, Lysholm score, Tegner activity level (TAL)). Binary logistic regression was used to assess the influence of the following factors on the need to undergo subsequent surgery: graft type (bQT vs. sQT), age group (>45 vs. <15, 15-30, and 31-45 years), preinjury TAL (0-3 vs. 4-6 and >7), gender (male vs. female), pivoting sports (pivoting vs. non-pivoting) and concomitant surgical interventions (isolated ACL vs. additional interventions).
Results
Complete outcome data at 12-month and 24-month follow-ups were available in 484 (bQT: 47.1%, sQT: 52.9%) and 301 patients, respectively. Patient in both groups did not differ regarding preoperative patient demographics and number of additional performed interventions. At final follow-up, no significant difference in mean Lysholm score (sQT: 90.6±10.6, bQT: 91.1±11.8), median TAL (sQT: 6 [1-10], bQT: 6 [1-10]) and VAS for pain (sQT: 0.8±11.8, bQT: 0.8±1.3) was reported between both groups. 77.4% (n = 374) of patients returned to or exceeded their preinjury activity level, with no significant differences between both groups (sQT-A: 76.9%, bQT: 77.7%). A total of 81 subsequent operations were performed; out of those 20 (4.1%; sQT: 3.9%, bQT: 4.3%) revision ACL surgeries and 30 (6.2%; sQT: 7.8%, bQT: 4.7%) contralateral ACL reconstructions. There was no statistically significant group difference in the rate of subsequent meniscal or ligamentous surgeries, however more patients in the sQT group (5.3%) underwent secondary cartilage surgery compared to those in the bQT group (1.2%; p = 0.01). Binary logistic regression indicated that the factors “age” (younger) and „activity level” (higher) had a significant value in predicting the need for subsequent surgery. None of the factors studied had a predictive value for the need for ACL revision surgery or contralateral ACL reconstruction.
Conclusion
Patients treated with sQT or bQT report similar postoperative patient-reported outcomes, have similar return to sport frequencies as well as ACL revision- and contralateral ACL surgery rates. The preoperative factor “age” (younger) and “activity level” (higher) had a significant value in predicting subsequent surgery.