John W Belk1, Matthew J Kraeutler2, Hayden A Marshall1, Jesse A Goodrich3, Eric C McCarty1. 1. Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado. 2. Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey. Electronic address: matthewkraeutlermd@gmail.com. 3. Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, U.S.A.
Abstract
PURPOSE: To systematically review the literature in an effort to compare outcomes of patients undergoing primary anterior cruciate ligament reconstruction (ACLR) with a quadriceps tendon (QT) autograft versus a bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autograft. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (Level of Evidence I-III) comparing the clinical outcomes of the QT autograft versus the BPTB or HT autograft in patients undergoing primary ACLR. Patients were evaluated based on graft failure rate, examination of knee laxity, and patient-reported outcome scores. RESULTS: Eight studies (1 Level II, 7 Level III) were identified that met inclusion criteria, including a total of 368 patients undergoing primary ACLR with a QT autograft, 225 with a BPTB autograft, and 150 with an HT autograft. The average follow-up duration for all patients was 2.9 years. Overall, 2.8% of patients (17/603) experienced graft failure. Within the studies that compared the QT versus BPTB autograft, no study found a significant difference in graft failure rate between groups, and the odds ratio for graft failure between QT and BPTB was found to be 1.58 (95% confidence interval: 0.49-5.07; P = .44). Within the studies that compared graft failure rate between the QT and HT autograft, none found significant differences between groups, although a meta-analysis was not performed because of a low number of trials. Two studies found significantly greater postoperative knee laxity in HT patients compared with QT patients (P < .05), although there were no significant differences found in laxity measurements between QT and BPTB patients. CONCLUSIONS: Patients undergoing primary ACLR with either a QT, BPTB, or HT autograft can all be expected to experience improvement in clinical outcomes. QT patients experienced less knee laxity postoperatively compared with HT patients, although no significant differences were found in graft failure rate between groups. LEVEL OF EVIDENCE: Level III, systematic review of Level II and III studies.
PURPOSE: To systematically review the literature in an effort to compare outcomes of patients undergoing primary anterior cruciate ligament reconstruction (ACLR) with a quadriceps tendon (QT) autograft versus a bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) autograft. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (Level of Evidence I-III) comparing the clinical outcomes of the QT autograft versus the BPTB or HT autograft in patients undergoing primary ACLR. Patients were evaluated based on graft failure rate, examination of knee laxity, and patient-reported outcome scores. RESULTS: Eight studies (1 Level II, 7 Level III) were identified that met inclusion criteria, including a total of 368 patients undergoing primary ACLR with a QT autograft, 225 with a BPTB autograft, and 150 with an HT autograft. The average follow-up duration for all patients was 2.9 years. Overall, 2.8% of patients (17/603) experienced graft failure. Within the studies that compared the QT versus BPTB autograft, no study found a significant difference in graft failure rate between groups, and the odds ratio for graft failure between QT and BPTB was found to be 1.58 (95% confidence interval: 0.49-5.07; P = .44). Within the studies that compared graft failure rate between the QT and HT autograft, none found significant differences between groups, although a meta-analysis was not performed because of a low number of trials. Two studies found significantly greater postoperative knee laxity in HTpatients compared with QT patients (P < .05), although there were no significant differences found in laxity measurements between QT and BPTB patients. CONCLUSIONS:Patients undergoing primary ACLR with either a QT, BPTB, or HT autograft can all be expected to experience improvement in clinical outcomes. QT patients experienced less knee laxity postoperatively compared with HTpatients, although no significant differences were found in graft failure rate between groups. LEVEL OF EVIDENCE: Level III, systematic review of Level II and III studies.
Authors: Christopher P Emerson; Jessica M Bernstein; Fong Nham; Spencer Barnhill; Michael G Baraga; Eric Bogner; Jean Jose Journal: Skeletal Radiol Date: 2019-05-16 Impact factor: 2.199
Authors: Scott R Brown; Edward P Washabaugh; Aviroop Dutt-Mazumder; Edward M Wojtys; Riann M Palmieri-Smith; Chandramouli Krishnan Journal: Sports Health Date: 2020-12-18 Impact factor: 3.843
Authors: Avinesh Agarwalla; Anirudh K Gowd; Joseph N Liu; Grant H Garcia; Daniel D Bohl; Nikhil N Verma; Brian Forsythe Journal: Orthop J Sports Med Date: 2019-02-19