Summary
Both HT and QT autograft are acceptable graft options in patients older than 50 years.
Abstract
Purpose
The purpose of this study was to compare the outcomes of HT and QT autografts for ACL reconstruction in patients older than 50 years in terms of patient-reported functional outcomes, graft failure rates, complications, return to sports activity and the preference for sports.
Methods
Between 2010 and 2020, prospectively collected data were obtained from an institutional database. Patients older than 50 years with primary arthroscopic ACL reconstruction using either HT or QT autograft and a minimum of 2 years of follow-up were included. Patients undergoing a revision ACL reconstruction or undergoing a primary ACL reconstruction using a graft other than HT or QT autograft, and patients with a contralateral knee injury or osteoarthritis (Ahlba¨ck stage 2 or higher) were excluded. A minimally invasive technique was used for QT autograft harvesting. Patients were evaluated for pre-injury and 2-year follow-up Lysholm knee score, Tegner activity level, Visual Analog Scale (VAS) for pain, graft failure, quadriceps tendon rupture, and return to sport.
Results
The number of patients in the QT and HT groups was 85 and 143 respectively. The two groups did not differ significantly in terms of age, gender and concomitant injuries. No significant differences were found in the pre-injury patient-reported outcome scores (PROMs) as Lysholm, Tegner activity level and VAS for pain between the two groups (p>0.05). At the 2-year follow-up Lysholm knee score, Tegner activity level and VAS for pain improved to pre-injury level and no significant difference was noted between pre-injury and 2-year follow-up functional scores (p>0.05). Furthermore, no significant differences were noted at the 2-year follow-up between the two groups for Lysholm knee score, Tegner activity score and VAS (p>0.05). The two groups did not differ in terms of sports participation at baseline, and 2 years of follow-up (p>0.05). A significant decrease in skiing/snowboarding was reported in the HT group at a 2-year follow-up compared to baseline. No incidence of graft failures and quadriceps tendon rupture was reported in either of the groups.
Conclusion
Arthroscopic ACL reconstruction by using HT or QT autograft in highly active older patients provides satisfactory patient-reported functional outcomes and allows recovery of the pre-injury level of activity. Both HT and QT autograft are acceptable graft options in patients older than 50 years.