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Outcomes for primary anterior cruciate reconstruction with the quadriceps autograft: a systematic review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine the suitability of the quadriceps autograft in primary anterior cruciate ligament (ACL) reconstruction.

Methods

A systematic review was undertaken to identify all clinical studies reporting on the use of the quadriceps tendon autograft in ACL reconstructions. Studies that reported on clinical and functional outcomes, morbidity and complications were selected.

Results

Seventeen articles met our inclusion criteria with a total of 1,580 reconstructions studied. This included four comparative studies which compared the quadriceps tendon to either hamstring or patella tendon autografts. The quadriceps tendon autograft had clinical (Lachman, Pivot-shift testing) and functional outcomes (Lysholm and IKDC scores) similar to those reported for the patella tendon and hamstring grafts in the literature. Comparative studies also reported no significant difference between the grafts for any outcome measure.

Conclusions

The quadriceps tendon autograft is a promising alternative for primary ACL reconstructions with good outcomes and minimal donor site morbidity. Further studies are required, however, to determine whether the quadriceps graft is as good as or better than other autografts.

Level of evidence

IV.

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References

  1. Blauth W (1984) 2-strip substitution-plasty of the anterior cruciate ligament with the quadriceps tendon. Unfallheilkunde 87:45–51

    PubMed  CAS  Google Scholar 

  2. Chen CH, Chou SW, Chen WJ, Shih CH, Ueng WN (2006) Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft–minimal 4-year follow-up (SS-14). Arthroscopy 20:e7

    Google Scholar 

  3. Chen CH, Chen WJ, Shih CH (1999) Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. J Trauma 46:678–682

    Article  PubMed  CAS  Google Scholar 

  4. Chen CH, Chuang TY, Chen LH, Chen WJ, Chen CH (2003) Comparison of quadruple hamstring graft and quadriceps (SS-05). Arthroscopy 19:SS-05

    Google Scholar 

  5. Clancy W (1985) Intra-articular reconstruction of the anterior cruciate ligament. Orthop Clin North Am 16:181–189

    PubMed  Google Scholar 

  6. DeAngelis JP, Fulkerson JP (2007) Quadriceps tendon–a reliable alternative for reconstruction of the anterior cruciate ligament. Clin Sports Med 26:587–596

    Article  PubMed  Google Scholar 

  7. Duquin T, Wind W, Fineberg M, Smolinski R, Buyea C (2009) Current trends in anterior cruciate ligament reconstruction. Knee Surg 22:7–12

    Article  Google Scholar 

  8. Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25

    PubMed  Google Scholar 

  9. Feller J, Webster K (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573

    PubMed  Google Scholar 

  10. Franke K (1976) Clinical experience in 130 cruciate ligament reconstructions. Orthop Clin North Am 7:191–193

    PubMed  CAS  Google Scholar 

  11. Freedman K, D’Amato M, Nedeff D, Kaz A, Bach B (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11

    PubMed  Google Scholar 

  12. Friedman M (1988) Arthroscopic semitendinosus (gracilis) reconstruction for anterior cruciate ligament deficiency. Tech Orthop 2:74–80

    Article  Google Scholar 

  13. Geib T, Shelton WR (2008) Arthroscopic Anterior cruciate ligament reconstruction utilizing quadriceps tendon autograft: intermediate results (SS-32). Arthroscopy 24:e17–e18

    Google Scholar 

  14. Gianotti S, Marshall S, Hume P, Bunt L (2009) Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 12:622–627

    Article  PubMed  Google Scholar 

  15. Goldblatt J, Fitzsimmons S, Balk E, Richmond J (2005) Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy 21:791–803

    Article  PubMed  Google Scholar 

  16. Gorschewsky O, Stapf R, Geiser L, Geitner U, Neumann W (2007) Clinical comparison of fixation methods for patellar bone quadriceps tendon autografts in anterior cruciate ligament reconstruction: absorbable cross-pins versus absorbable screws. Am J Sports Med 35:2118–2125

    Article  PubMed  Google Scholar 

  17. Han HS, Seong SC, Lee S, Lee MC (2008) Anterior cruciate ligament reconstruction: quadriceps versus patellar autograft. Clin Orthop Relat Res 466:198–204

    Article  PubMed  Google Scholar 

  18. HeyGroves EW (1917) Operation for the repair of the cruciate ligament. Lancet 2:674–675

    Article  Google Scholar 

  19. Kim SJ, Jo SB, Kumar P, Oh KS (2009) Comparison of single- and double-bundle anterior cruciate ligament reconstruction using quadriceps tendon-bone autografts. Arthroscopy 25:70–77

    Article  PubMed  Google Scholar 

  20. Kim SJ, Kumar P, Oh KS (2009) Anterior cruciate ligament reconstruction: autogenous quadriceps tendon-bone compared with bone-patellar tendon-bone grafts at 2-year follow-up. Arthroscopy 25:137–144

    Article  PubMed  Google Scholar 

  21. Lee S, Seong SC, Jo CH, Han HS, An JH, Lee MC (2007) Anterior cruciate ligament reconstruction with use of autologous quadriceps tendon graft. J Bone Joint Surg Am 89(Suppl 3):116–126

    Article  PubMed  Google Scholar 

  22. Lee S, Seong SC, Jo H, Park YK, Lee MC (2004) Outcome of anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthroscopy 20:795–802

    PubMed  Google Scholar 

  23. Legnani C, Ventura A, Terzaghi C, Borgo E, Albisetti W (2010) Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature. Int Orthop 34:465–471

    Article  PubMed  Google Scholar 

  24. Leitman EH, Morgan CD, Grawl DM (1999) Quadriceps tendon anterior cruciate ligament reconstruction using the all-inside technique. Op Tech Sports Med 7:179–188

    Article  Google Scholar 

  25. Magnussen RA, Carey JL, Spindler KP (2010) Does autograft choice determine intermediate-term outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 19:462–472

    Article  PubMed  Google Scholar 

  26. Mohtadi N, Chan D, Dainty K, Whelan D (2011) Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults (Review). Cochrane Rev PMID:21901700

  27. Nakamura N, Horibe S, Sasaki S (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18:598–602

    Article  PubMed  Google Scholar 

  28. Noronha JC (2002) Reconstruction of the anterior cruciate ligament with quadriceps tendon. Arthroscopy 18:E37p1–E37p5

    Google Scholar 

  29. Noyes F, Butler D, Grood E, Zernicke R, Hefzy M (1984) Biomechanical analysis of human ligament grafts used in knee ligament repairs and reconstructions. J Bone Joint Surg Am 66:344–352

    PubMed  CAS  Google Scholar 

  30. Pinczewski L, Lyman J, Salmon L, Russell V, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  31. Prodromos CC, Fu FH, Howell SM, Johnson DH, Lawhorn K (2008) Controversies in soft-tissue anterior cruciate ligament reconstruction: grafts, bundles, tunnels, fixation, and harvest. J Am Acad Orthop Surg 16:376–384

    PubMed  Google Scholar 

  32. Prodromos CC, Joyce B, Shi K, Keller B (2007) A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 15:851–856

    Article  PubMed  Google Scholar 

  33. Reinhardt KR, Hetsroni I, Marx RG (2010) Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am 41:249–262

    Article  PubMed  Google Scholar 

  34. Sachs R, Daniel D, Stone M, Garfein R (1989) Patellofemoral problems after anterior cruciate ligament reconstruction. Am J Sports Med 17:760–765

    Article  PubMed  CAS  Google Scholar 

  35. Sarrafan N, Mehdinasab SA (2008) Anterior cruciate ligament reconstruction using the patella tendon and quadriceps tendon: a comparative study. Pak J Med Sci 24:416–419

    Google Scholar 

  36. Schindler O (2012) Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc 20:5–47

    Article  PubMed  Google Scholar 

  37. Shelton WR, Fagan BC (2011) Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 19:259–264

    PubMed  Google Scholar 

  38. Shelton WR, Holt S (2004) Quadriceps tendon anterior cruciate ligament reconstruction (SS-15). Arthroscopy 20:e7

    Google Scholar 

  39. Shermann O, Banffy M (2004) Anterior cruciate ligament reconstruction: which graft is best? Arthroscopy 20:974–980

    Google Scholar 

  40. Stanish WD, Kirkpatrick J, Rubinovich RM (1984) Reconstruction of the anterior cruciate ligament with a quadricep patellar tendon graft. Preliminary results. Can J Appl Sport Sci 9:21–24

    PubMed  CAS  Google Scholar 

  41. Theut PC, Fulkerson JP, Armour EF, Joseph M (2003) Anterior cruciate ligament reconstruction utilizing central quadriceps free tendon. Orthop Clin North Am 34:31–39

    Article  PubMed  Google Scholar 

  42. West RV, Harner CD (2005) Graft selection in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 13:197–207

    PubMed  Google Scholar 

  43. Woo SY, Hollis J, Adams D, Lyon R, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament- tibia complex: The effects of specimen age and orientation. Am J Sports Med 19:217–225

    Google Scholar 

  44. Zoltan D, Reinecke C, Indelicato P (1988) Synthetic and allograft anterior cruciate ligament reconstruction. Clin Sports Med 7:773–784

    PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic, Prince of Wales Hospital, Barker Street, Randwick, Sydney, NSW, 2031, Australia

    Jonathan S. Mulford, Stephen E. Hutchinson & Jacqueline R. Hang

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  1. Jonathan S. Mulford
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  2. Stephen E. Hutchinson
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  3. Jacqueline R. Hang
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Correspondence to Jonathan S. Mulford.

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Mulford, J.S., Hutchinson, S.E. & Hang, J.R. Outcomes for primary anterior cruciate reconstruction with the quadriceps autograft: a systematic review. Knee Surg Sports Traumatol Arthrosc 21, 1882–1888 (2013). https://doi.org/10.1007/s00167-012-2212-2

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  • DOI: https://doi.org/10.1007/s00167-012-2212-2

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