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. 2025 Feb 6;13(2):23259671241311916.
doi: 10.1177/23259671241311916. eCollection 2025 Feb.

Comparison of Arthrofibrosis After ACL Reconstruction According to Graft Choice: Quadriceps Tendon Versus Bone-Patellar Tendon-Bone Autograft

Bailey E Johnson  1 , Chelsea L Smith  1 , Cory D Smith  1 , Edward J Quilligan  1 , Viraj A Deshpande  1 , Vance O Gardner  1 , Kevin C Parvaresh  1 , Michael F Shepard  1 , Russell S Petrie  1 , Carlos A Prietto  1 , Robert C Grumet  1 , David S Gazzaniga  1
Affiliations

Comparison of Arthrofibrosis After ACL Reconstruction According to Graft Choice: Quadriceps Tendon Versus Bone-Patellar Tendon-Bone Autograft

Bailey E Johnson et al. Orthop J Sports Med. .

Abstract

Background: Arthrofibrosis is a complication of anterior cruciate ligament reconstruction (ACLR), and it is possible that graft choice such as the quadriceps tendon (QT) autograft may be a risk factor. With the increasing popularity of the QT autograft, it is important to compare it with other graft choices.

Purpose/hypothesis: The purpose of this study was to identify whether graft choice, QT versus bone-patellar tendon-bone (BTB) autograft, is a risk factor for early return to the operating room for arthrofibrosis after ACLR. It was hypothesized that the rate of arthrofibrosis surgery would be higher for the QT autograft recipients.

Study design: Cohort study; Level of evidence, 3.

Methods: A single-center retrospective chart review was conducted between January 2010 and November 2022. Skeletally mature patients who underwent primary ACLR with either QT or BTB autograft were considered for inclusion. Patients who received an alternate graft or those undergoing revision ACLR were excluded. The primary outcome of interest was return to the operating room for arthrofibrosis release (either manipulation under anesthesia or lysis of adhesions).

Results: Of 1726 included patients (1155 receiving a BTB autograft and 571 receiving a QT autograft), 5.2% (n = 60) of BTB recipients and 6.5% (n = 37) of QT recipients required subsequent arthrofibrosis. There was no significant association between graft type and subsequent arthrofibrosis (P = .275). There was a significant association with graft type and presence of a cyclops lesion (65.0% of BTB grafts and 40.5% of QT grafts; P = .018). After removing those patients with chronic tears who underwent ACLR at >1 year, patients who required arthrofibrosis were found to have a significantly shorter time between injury and ACLR (mean, 59.23 ± 48.46 days) than those who did not require arthrofibrosis (mean, 81.7 ± 72.63 days) (P≤ .01). Significantly more female patients (9.25%) than male patients (2.79%) required arthrofibrosis (hazard ratio, 3.82; P < .001), and patients who required arthrosis were significantly younger (mean, 22.52 ± 9.35 years) than those who did not (mean, 25.74 ± 10.83 years) (P = .001).

Conclusion: Study findings indicated no statistically significant difference in the rate of secondary arthrofibrosis surgery between patients who underwent ACLR with either QT or BTB autograft.

Keywords: ACL; biomechanics of ligament; general sports trauma; knee ligaments.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.E.J. has received grant support from Arthrex, education payments from Medwest Associates and Smith & Nephew, and hospitality payments from Zimmer Biomet Holdings. C.D.S. has received grant support from Arthrex and education payments from Smith & Nephew and Peerless Surgical. V.O.G. has received consulting fees from Surgalign Spine Technologies. K.C.P. has received grant support from Acumed and Arthrex; education payments from Micromed, Medwest, and Smith & Nephew; consulting fees from Encore Medical; and hospitality payments from Stryker. R.S.P. has received education payments from Micromed and hospitality payments from Arthrex. R.C.G. has received education payments from Micromed and Saxum Surgical and hospitality payments from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from WCG IRB (reference No. 20226218).

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