Summary
This study represents the largest available single-surgeon series of consecutive ACLR with QT autograft, and at a minimum 1-year follow-up, there is a 98% graft survival rate and a 2% donor-site morbidity rate.
Abstract
Introduction
Anterior cruciate ligament reconstruction (ACLR) remains one of the most commonly performed surgeries worldwide. Over the last decade, quadriceps tendon (QT) autograft utilization has increased. Despite its growth in popularity, early complications and learning curve associated with performing ACLR with QT autograft with modern techniques is poorly understood. The purpose of this study was to evaluate the learning curve and outcomes of performing an ACLR with QT autograft by a single surgeon using modern graft harvest and fixation techniques.
Methods
A retrospective review of prospectively collected data was conducted utilizing the University of Colorado (CU) Sports Medicine Registry. The first 100 consecutive patients undergoing primary ACLR using QT autograft with a minimum 1-year follow-up performed by a single surgeon from 2021-2023 were identified. All patients underwent QT harvest using a minimally invasive technique, resulting in a full-thickness, all-soft tissue graft. All grafts underwent suspensory fixation. Exclusion criteria included revision reconstruction, skeletal immaturity, or multiligament reconstruction. Preoperative and postoperative patient-reported outcome (PRO) scores, including Pain VAS, Knee SANE, IKDC, PROMIS-PF, and PROMIS-PI were analyzed. Data on complications, reoperations, reinjury, and donor-site morbidity were analyzed. Standard statistical analysis was performed with significance determined for P<0.05.
Results
A total of 100 consecutive patients with an average age of 31±6 years (61% female) with a minimum 1-year follow-up were included. Fifteen patients (15%) underwent concurrent lateral extra-articular tenodesis, and 37 patients (37%) underwent concurrent meniscus repair surgery. There were no complications related to infection, graft fixation, or hardware irritation. There were 12 minor complications (12%), with 11 patients (11%) requiring repeat surgery. Complications requiring reoperation included suture abscess (N=1), surgical site hematoma (N=1), reactive non-septic synovitis (N=1), arthrofibrosis (N=6, including 3 with concurrent meniscus repair at time of ACLR), and revision ACLR (N=2). The two patients requiring revision ACLR sustained traumatic re-injuries while playing soccer (15-year-old female at 12 months, 17-year-old male at 16 months) after making a full return to sports. The one complication not requiring reoperation was DVT (1%, N=1). All PROs significantly improved from baseline to one year postoperatively (P<0.05 for all).
Discussion
ACLR with all-soft tissue, full-thickness QT autograft results in excellent clinical outcomes with low failure rates at a minimum 1-year follow-up. These early findings suggest that this graft choice is effective and reliable treatment option, even early on in a surgeon’s learning curve. Arthrofibrosis was the most common complication noted in 6/100 patients, and of these patients, 3 underwent concurrent meniscus repair at the time of their ACLR, potentially contributing to this finding.
Conclusion
This study represents the largest available single-surgeon series of consecutive ACLR with QT autograft. At a minimum 1-year follow-up, there is a 98% graft survival rate and a 2% donor-site morbidity rate. At short-term follow-up, there are statistically significant and clinically relevant improvements in PROs, including IKDC and PROMIS scores. Additional analyses of this cohort, reporting on return to sport, , graft survivorship, and satisfaction are underway.