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. 2023 Jun;31(6):2461-2468.
doi: 10.1007/s00167-022-07200-2. Epub 2022 Oct 20.

Revision ACL reconstruction using quadriceps, hamstring and patellar tendon autografts leads to similar functional outcomes but hamstring graft has a higher tendency of graft failure

Amit Meena  1   2 , Luca Farinelli  3 , Christian Hoser  1   2 , Elisabeth Abermann  1   2 , Akshya Raj  4 , Caroline Hepperger  1 , Mirco Herbort  2   5 , Christian Fink  6   7
Affiliations

Revision ACL reconstruction using quadriceps, hamstring and patellar tendon autografts leads to similar functional outcomes but hamstring graft has a higher tendency of graft failure

Amit Meena et al. Knee Surg Sports Traumatol Arthrosc. 2023 Jun.

Abstract

Purpose: The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts.

Methods: Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40 patients received a QT, 26 an HT and 31 a BPTB graft) met the inclusion criteria. Pre-injury and at 2-year postoperatively patients were evaluated for patient-reported functional outcomes; Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; and graft failure. Patient-reported outcomes and graft failure were compared between the QT, HT and BPTB groups. The patients with graft failure were not included for outcome analysis at 2-years of follow-up.

Results: All three revision groups with QT, HT and BPTB autograft did not differ significantly in terms of age, sex, time from injury to surgery, concomitant injuries and single-stage or double-stage procedures (n.s.). No significant difference was found in the pre-injury patient-reported outcome; Lysholm knee score, Tegner activity and VAS for pain (n.s.) between the three groups. At the 2-year follow-up functional outcomes improved in all three groups and all the patients returned to pre-injury activity level; however, no significant difference was found in functional outcomes at the 2-year follow-up between the three groups (n.s.). Graft failure occurred in 4 (10%), 5 (19%) and 3 (10%) patients of QT, HT and BPTB groups, respectively. However, the rate of failure did not differ significantly between groups.

Conclusion: All three autografts (QT, HT and BPTB) demonstrated satisfactory patient-reported outcomes in revision ACL reconstruction. Compared with QT and BPTB grafts, HT graft showed a higher tendency for failure rates. With the increasing incidence of revision ACL reconstruction, surgeons should be aware of all the available graft options. The findings of this study will assist the surgeons in the graft selection for revision ACL reconstruction.

Level of evidence: Level III.

Keywords: ACL; Anterior cruciate ligament; Autograft; BPTB; Functional outcome; Graft failure; HT; Hamstring tendon; Patellar tendon; QT; Quadriceps tendon; Revision.

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Conflict of interest statement

The authors declare that they have no conflict of interest related to this study.

Figures

Fig. 1
Fig. 1
Patient-reported outcomes measures. BPTB Bone patellar tendon bone, QT quadriceps tendon, HT hamstring tendon. X: mean
See this image and copyright information in PMC

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