gms | German Medical Science

Objectives: To compare quadriceps tendon- (QT-A) and hamstring tendon (HT-A) autograft in primary anterior cruciate ligament reconstruction (ACLR) in patients with a minimum of 5 years follow-up (FU).

Methods: Between 2010 and 2014, all patients undergoing ACLR (QT: 119, HT: 511) were recorded in a prospectively administered database. Patients with primary, isolated QT-A ACLR were matched by sex, duration of follow-up (±12 month), age (±3 years) and Tegner activity score (±1 point) to patients treated with isolated HT-A. Patients without any subsequent ipsi- or contralateral ACL injury were invited for clinical follow up. Anterior-posterior (ap) knee laxity, single-leg-hop test (SLHT) performance and distal thigh circumference (DTC) were measured. Furthermore, subjective and objective IKDC, KOOS, Lysholm and Shelbourne-Trumper (SH-) scores, Tegner activity level (TAL), VAS for pain as well as the Patient and Observer Scar Assessment Scale (POSAS) were obtained.

Between-group comparisons were performed using chi-square-, independent-samples T- or Mann-Whitney-U tests.

Results and Conclusion: Out of 119 ACLR using QT-A, 70 (58.8%) patients were excluded due to additional surgical interventions, arthrosis or previous ACLR. Four (3.4%) patients were lost to FU. Finally 45 QT-A patients were matched to 45 HT-A patients (n=90). The mean FU was 78.9±13.6 months. 18 subjects (20.0%; QT: n=8, 17.8%; HT: n=10, 22.2%; p=.60) sustained a graft rupture and 17 patients (18.8%; QT: n=9, 20.0%; HT: n=8 , 17.8%; p=.79) suffered a contralateral ACL injury. The mean side-to-side difference (SSD) in ap-translation was 1.9±1.2mm for the QT-A and 2.1±1.5mm for the HT-A (p=.77). The objective IKDC grade between the QT- and HT-group revealed a grade "A" in 76.9% and 57.1% (p=.12), and a grade "B" in 23.1% and 39.3% patients (p=.20), respectively.

No statistical differences were found in the subjective IKDC- (QT: 93.8±6.7, HT: 91.2±7.7, p=.17), Lysholm- (QT: 91.9±7.2, HT: 91.5±9.7, p=.84) or any of the five subscales of the KOOS score (all p>.05). Furthermore, TAL (QT: 5.6±1.7, HT: 5.3±1.4, p=.64), VAS for pain (QT: 0.5±0.9, HT: 0.6±1.0, p=.61), SH- (QT: 96.4±5.5, HT: 92.1±18.9, p=.24), POSAS score (QT: 9.4±3.2, HT: 10.6± 4.9, p=.25) and DTC (injured vs. uninjured: QT: 0.5±0.5, HT: 0.5±0.6, p=.97) were not significantly different between both groups.

Significantly more patients in the HT-group (n=14, 46.7%) reported persisting sensory deficits at the proximal lower leg (QT: n=3, 11.5%; p=.004) with a mean area of deficit of 114.3cm2 (QT: 40.4 cm2, p= 0.07).

Five (17.6%) patients in the HT group and one (5.6%) in the QT group had a side-to-side difference greater than 10% in the SLHT (p=.18).

The use of QT-A in isolated, primary ACLR leads to equal clinical, functional and patient-reported outcomes when compared to HT-A. About every fifth patients sustains a subsequent ipsi- or contralateral ACL injury at medium-term FU. Patients treated with HT-A have an increased incidence of donor site morbidity at the lower leg.