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German Congress of Orthopaedics and Traumatology (DKOU 2021)

26. - 29.10.2021, Berlin

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Partially layered quadriceps-tendon autografts provide lower failure rates and improved clinical results compared to hamstring tendon grafts in revision ACL surgery

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  • presenting/speaker Lena Alm - BG Klinikum Hamburg, Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, Hamburg, Germany
  • Stefan Breer - BG Klinikum Hamburg, Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, Hamburg, Germany
  • Tobias C. Drenck - BG Klinikum Hamburg, Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, Hamburg, Germany
  • Karl-Heinz Frosch - Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
  • Ralph Akoto - BG Klinikum Hamburg, Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, Hamburg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2021). Berlin, 26.-29.10.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocAB30-582

doi: 10.3205/21dkou123, urn:nbn:de:0183-21dkou1236

Published: October 26, 2021

© 2021 Alm et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives: We developed a quadriceps-tendon graft technique using a long, partially layered soft tissue quadriceps tendon graft (plQUAD) for anterior cruciate ligament reconstruction (ACLR).

The aim of this study was to evaluate the outcome of patients with revision ACLR using the plQUAD technique compared to a hamstring tendon graft (HT).

Methods: Between 2017 and 2018, 95 patients who underwent revision ACLR were included in the retrospective case series. With a follow up of 26.9 ± 3.7 (mean±SD, 24 to 36) months, 89 patients (plQUAD: n=43, HT: n= 46) were clinically examined after revision surgery. Postoperative failure of the revision ACLR was defined as side-to-side difference (SSD) in Rolimeter® testing > 5mm or pivot shift grade 2/3.

Results and Conclusion: In total, 9 patients (10.1%) were identified with a failed revision ACLR, while patients with plQUAD had a significant lower failure rate compared to HT (2.3% vs. 17.4%, p=0.031). The mean postoperative SSD was also significantly reduced in the plQUAD group (1.3 ± 1.3mm (0-5) vs. 1.8 ± 2.2mm (0-9), p=0.043) in Rolimeter testing. The preoperative Lachman and pivot- shift test significantly improved in both groups (p<0.001) and patient-related outcome including Tegner and IKDC was significantly increased in the plQUAD group compared to the HT group (Tegner score 5.8 ± 1.8 vs. 5.6 ± 1.5, p=0.043 and IKDC 83.8 ± 12.2 vs. 78.6 ± 16.8, p=0.037) at the latest follow-up. Pain was also significantly reduced in the plQUAD group than in the HT group (0.9 ± 1.1 to 1.6 ± 2 points (p=0.014) according to the VAS scale at the time of follow-up.

The plQUAD technique demonstrates significant improvement of preoperative knee laxity and satisfactory patient-related outcome measures. Compared to the hamstring tendon grafts, the plQUAD technique showed lower failure rates and increased Tegner and IKDC in revision ACLR.