|Beitragstitel||Primary ACL reconstruction using quadriceps tendon vs hamstring autograft - a comparative study with a mean follow-up of 3.6 years|
The quadriceps tendon (QT) autograft is known as an effective graft for primary ACL reconstruction with similar functional outcome as the bone-patellar tendon-bone (BPTB) and a lesser incidence of reported complications. No comparative study of QT vs. hamstring (HT) autograft has been published using identical surgical technique and including more than 50 knees in literature.
Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012, wherefrom 50 with QT (with a patellar bone block, BQT) and 45 with a pediculated 4 stranded HT autograft (using gracilis and semitendinosus) were included in this study. Surgical technique with outside-in tunnel drilling and graft fixation with interference screws, and postoperative rehabilitation protocol, were identical.
Postoperative results were evaluated by using functional outcome scores (Lysholm, KOOS, Tegner, subjective IKDC), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne–Trumper score), isokinetic strength (at 90°/s using the Con-Trex Multi Joint System®), and surgical revision.
Descriptive statistics are presented for these variables using Student’s t-test.
Eighty-six patients (45 BQT, 41 HT) agreed to participate in this prospective follow-study (3.6 ± 0.4 years, minimal follow-up 3years). The functional outcome scores were all significantly better in the BQT group than in the HT group at final follow-up (Lysholm (89 ± 6.9 vs. 81 ± 5.3), KOOS Symptoms (90 ± 11.2 vs. 81 ± 10.3) and KOOS Sport (82 ± 11.3 vs. 67 ± 12.4)). In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the BQT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements (P < 0.005). The negative Lachman (90% vs. 46 %, P < 0.005) and Pivot shift (90% vs. 64 %, P = 0.052) component was higher in the BQT group than the HT group. The Shelbourne–Trumper score for anterior knee pain was the same in both groups. There was no difference between groups in terms of isokinetic strength. There were four re-operations in the QT group (including one ACL revision) and three in the HT group (including two ACL revisions) (P > 0.05).
The use of BQT autograft in primary ACL reconstruction leads to at least equal or even better functional results compared to the use of a quadrupled HT autograft, without increased anterior knee pain or other donor-side morbidity.