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European Journal of Orthopaedic Surgery & Traumatology

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Open Access 01-10-2020 | General Review

Quadriceps tendon autograft for primary ACL reconstruction: a Bayesian network meta-analysis

Authors: Filippo Migliorini, Jörg Eschweiler, Yasser El Mansy, Valentin Quack, Markus Tingart, Arne Driessen

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 7/2020

Abstract

Background

The purpose of the current study was to clarify the role of the quadriceps tendon (QT) autograft for primary ACL reconstruction. Thus, a Bayesian network meta-analysis comparing patients undergoing a primary ACL reconstruction with QT versus patellar tendon (PT) and hamstring tendon (HT) autografts was conducted.

Material and methods

This Bayesian network meta-analysis was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of health care interventions. In January 2020, the main databases were accessed. Articles comparing the outcomes of the QT autograft versus HT autograft and/or PT autograft for primary ACL reconstruction were included in the present study. The statistical analysis was performed with STATA Software/MP, through a Bayesian hierarchical random-effect model analysis.

Results

Data from a total of 2603 knees were analysed. The overall mean follow-up was 35.0 months. Among the different grafts were evidenced comparable values of IKDC, Tegner and Lysholm score. The QT autograft detected comparable rate of Lachman test > 3 mm, Pivot shift test > 3 m and instrumental laxity > 3 mm. The QT autograft showed a lower rate of autograft failure above all. The QT autograft detected the reduced rate of AKP than the PT.

Conclusion

Quadriceps tendon autograft may represent a feasible option for primary ACL reconstruction. These results must be interpret within the limitations of the present network meta-anlaysis.

Mall NA, Chalmers PN, Moric M et al (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42:2363–2370 CrossRefPubMed

Filbay SR, Grindem H (2019) Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol 33(1):33–47. https://doi.org/10.1016/j.berh.2019.01.018CrossRefPubMedPubMedCentral

Achtnich A, Metzlaff S, Zantop T (2013) Technique of anatomical footprint reconstruction of the ACL with oval tunnels and medial portal aimers. Arch Orthop Trauma Surg 133(6):827–833CrossRefPubMed

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

Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, 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(4):564–574. https://doi.org/10.1177/0363546506296042CrossRefPubMed

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

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 31:19–25CrossRefPubMed

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

Romanini E, D’Angelo F, Masi SD et al (2010) Graft selection in arthroscopic anterior cruciate ligament reconstruction. J Orthop Traumatol 11:211–219CrossRefPubMedPubMedCentral

10.

Sasaki N, Farraro KF, Kim KE, Woo SL (2014) Biomechanical evaluation of the quadriceps tendon autograft for anterior cruciate ligament reconstruction: a cadaveric study. Am J Sports Med 42(3):723–730. https://doi.org/10.1177/0363546513516603CrossRefPubMedPubMedCentral

11.

Harris NL, Smith D, Lamoreaux L, Purnell M (1997) Central quadriceps tendon for anterior cruciate ligament reconstruction. Part I: morphometric and biomechanical evaluation. Am J Sports Med 25:23–28 CrossRefPubMed

12.

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP, Mulrow C, Catala-Lopez F, Gotzsche PC, Dickersin K, Boutron I, Altman DG, Moher D (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784. https://doi.org/10.7326/M14-2385CrossRefPubMed

13.

Howick J CI, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H, Goddard O, Hodgkinson M (2011) The 2011 Oxford levels of evidence. oxford centre for evidence-based medicine. Available at https://www.cebmnet/indexaspx?o=5653

14.

Irrgang JJ, Anderson A, Boland AL et al (2001) Development and valida- tion of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613CrossRefPubMed

15.

Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154CrossRefPubMed

16.

Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37(5):890–897. https://doi.org/10.1177/0363546508330143CrossRefPubMed

17.

Arneja S, Leith J (2009) Review article: Validity of the KT-1000 knee ligament arthrometer. J Orthop Surg (Hong Kong) 17(1):77–79. https://doi.org/10.1177/230949900901700117CrossRef

18.

Paine R, Lowe W (2012) Comparison of Kneelax and KT-1000 knee ligament arthrometers. J Knee Surg 25(2):151–154CrossRefPubMed

19.

Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F (2004) Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 86(10):2143–2155CrossRefPubMed

20.

Akoto R, Albers M, Balke M, Bouillon B, Hoher J (2019) ACL reconstruction with quadriceps tendon graft and press-fit fixation versus quadruple hamstring graft and interference screw fixation—a matched pair analysis after one year follow up. BMC Musculoskelet Disord 20(1):109. https://doi.org/10.1186/s12891-019-2499-yCrossRefPubMedPubMedCentral

21.

Barenius B, Nordlander M, Ponzer S, Tidermark J, Eriksson K (2010) Quality of life and clinical outcome after anterior cruciate ligament reconstruction using patellar tendon graft or quadrupled semitendinosus graft: an 8-year follow-up of a randomized controlled trial. Am J Sports Med 38(8):1533–1541. https://doi.org/10.1177/0363546510369549CrossRefPubMed

22.

Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J (2017) Is quadriceps tendon autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3.6 years. Am J Sports Med 45(6):1326–1332. https://doi.org/10.1177/0363546516688665CrossRefPubMed

23.

Drogset JO, Strand T, Uppheim G, Odegard B, Boe A, Grontvedt T (2010) Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 18(8):1085–1093. https://doi.org/10.1007/s00167-009-0996-5CrossRefPubMed

24.

Feller JA, Webster KE, Gavin B (2001) Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft. Knee Surg Sports Traumatol Arthrosc 9(5):260–266. https://doi.org/10.1007/s001670100216CrossRefPubMed

25.

Geib TM, Shelton WR, Phelps RA, Clark L (2009) Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy 25(12):1408–1414. https://doi.org/10.1016/j.arthro.2009.06.004CrossRefPubMed

26.

Gorschewsky O, Klakow A, Putz A, Mahn H, Neumann W (2007) Clinical comparison of the autologous quadriceps tendon (BQT) and the autologous patella tendon (BPTB) for the reconstruction of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 15(11):1284–1292. https://doi.org/10.1007/s00167-007-0371-3CrossRefPubMed

27.

Han HS, Seong SC, Lee S, Lee MC (2008) Anterior cruciate ligament reconstruction : quadriceps versus patellar autograft. Clin Orthop Relat Res 466(1):198–204. https://doi.org/10.1007/s11999-007-0015-4CrossRefPubMedPubMedCentral

28.

Haner M, Bierke S, Petersen W (2016) Anterior cruciate ligament revision surgery: ipsilateral quadriceps versus contralateral semitendinosus-gracilis autografts. Arthroscopy 32(11):2308–2317. https://doi.org/10.1016/j.arthro.2016.03.020CrossRefPubMed

29.

Hart R, Kucera B, Safi A (2010) Hamstring versus quadriceps tendon graft in double-bundle anterior cruciate ligament reconstruction. Acta Chir Orthop Traumatol Cech 77(4):296–303PubMed

30.

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(2):137–144. https://doi.org/10.1016/j.arthro.2008.09.014CrossRefPubMed

31.

Kim SJ, Lee SK, Choi CH, Kim SH, Kim SH, Jung M (2014) Graft selection in anterior cruciate ligament reconstruction for smoking patients. Am J Sports Med 42(1):166–172. https://doi.org/10.1177/0363546513505191CrossRefPubMed

32.

Lee JK, Lee S, Lee MC (2016) Outcomes of anatomic anterior cruciate ligament reconstruction: bone-quadriceps tendon graft versus double-bundle hamstring tendon graft. Am J Sports Med 44(9):2323–2329. https://doi.org/10.1177/0363546516650666CrossRefPubMed

33.

Lund B, Nielsen T, Fauno P, Christiansen SE, Lind M (2014) Is quadriceps tendon a better graft choice than patellar tendon? a prospective randomized study. Arthroscopy 30(5):593–598. https://doi.org/10.1016/j.arthro.2014.01.012CrossRefPubMed

34.

Maletis GB, Cameron SL, Tengan JJ, Burchette RJ (2007) A prospective randomized study of anterior cruciate ligament reconstruction: a comparison of patellar tendon and quadruple-strand semitendinosus/gracilis tendons fixed with bioabsorbable interference screws. Am J Sports Med 35(3):384–394. https://doi.org/10.1177/0363546506294361CrossRefPubMed

35.

Martin-Alguacil JL, Arroyo-Morales M, Martin-Gomez JL, Monje-Cabrera IM, Abellan-Guillen JF, Esparza-Ros F, Lozano ML, Cantarero-Villanueva I (2018) Strength recovery after anterior cruciate ligament reconstruction with quadriceps tendon versus hamstring tendon autografts in soccer players: a randomized controlled trial. Knee 25(4):704–714. https://doi.org/10.1016/j.knee.2018.03.011CrossRefPubMed

36.

Mohtadi N, Chan D, Barber R, Oddone Paolucci E (2015) A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle acl reconstructions: patient-reported and clinical outcomes at a minimal 2-year follow-up. Clin J Sport Med 25(4):321–331. https://doi.org/10.1097/JSM.0000000000000165CrossRefPubMed

37.

Runer A, Wierer G, Herbst E, Hepperger C, Herbort M, Gfoller P, Hoser C, Fink C (2018) There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sports Traumatol Arthrosc 26(2):605–614. https://doi.org/10.1007/s00167-017-4554-2CrossRefPubMed

38.

Sofu H, Sahin V, Gursu S, Yildirim T, Issin A, Ordueri M (2013) Use of quadriceps tendon versus hamstring tendon autograft for arthroscopic anterior cruciate ligament reconstruction: a comparative analysis of clinical results. Eklem Hastalik Cerrahisi 24(3):139–143. https://doi.org/10.5606/ehc.2013.31CrossRefPubMed

39.

Taylor DC, DeBerardino TM, Nelson BJ, Duffey M, Tenuta J, Stoneman PD, Sturdivant RX, Mountcastle S (2009) Patellar tendon versus hamstring tendon autografts for anterior cruciate ligament reconstruction: a randomized controlled trial using similar femoral and tibial fixation methods. Am J Sports Med 37(10):1946–1957. https://doi.org/10.1177/0363546509339577CrossRefPubMed

40.

Todor A, Nistor DV, Caterev S (2019) Clinical outcomes after ACL reconstruction with free quadriceps tendon autograft versus hamstring tendons autograft. A retrospective study with a minimal follow-up two years. Acta Orthop Traumatol Turc 53(3):180–183. https://doi.org/10.1016/j.aott.2019.03.004CrossRefPubMedPubMedCentral

41.

Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH (2011) Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy 27(5):653–665. https://doi.org/10.1016/j.arthro.2011.01.015CrossRefPubMed

42.

Zaffagnini S, Marcacci M, Lo Presti M, Giordano G, Iacono F, Neri MP (2006) Prospective and randomized evaluation of ACL reconstruction with three techniques: a clinical and radiographic evaluation at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 14(11):1060–1069. https://doi.org/10.1007/s00167-006-0130-xCrossRefPubMed

43.

Agel J, LaPrade RF (2009) Assessment of differences between the modified cincinnati and international knee documentation committee patient outcome scores: a prospective study. Am J Sports Med 37(11):2151–2157. https://doi.org/10.1177/0363546509337698CrossRefPubMed

44.

Sajovic M, Stropnik D, Skaza K (2018) Long-term comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: a 17-year follow-up of a randomized controlled trial. Am J Sports Med 46(8):1800–1808. https://doi.org/10.1177/0363546518768768CrossRefPubMed

45.

Webster KE, Feller JA, Hartnett N, Leigh WB, Richmond AK (2016) Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med 44(1):83–90. https://doi.org/10.1177/0363546515611886CrossRefPubMed

46.

Ryan J, Magnussen RA, Cox CL, Hurbanek JG, Flanigan DC, Kaeding CC (2014) ACL reconstruction: do outcomes differ by sex? A systematic review. J Bone Joint Surg Am 96(6):507–512. https://doi.org/10.2106/JBJS.M.00299CrossRefPubMed

47.

Rezende FC, de Moraes VY, Martimbianco AL, Luzo MV, da Silveira Franciozi CE, Belloti JC (2015) Does combined intra- and extraarticular acl reconstruction improve function and stability? A Meta-analysis Clin Orthop Relat Res 473(8):2609–2618. https://doi.org/10.1007/s11999-015-4285-yCrossRefPubMed

48.

Thorlund JB, Creaby MW, Wrigley TV, Metcalf BR, Bennell KL (2014) Knee joint laxity and passive stiffness in meniscectomized patients compared with healthy controls. Knee 21(5):886–890. https://doi.org/10.1016/j.knee.2014.06.001CrossRefPubMed

49.

Dejour H, Walch G, Deschamps G, Chambat P (2014) Arthrosis of the knee in chronic anterior laxity. Orthop Traumatol Surg Res 100(1):49–58. https://doi.org/10.1016/j.otsr.2013.12.010CrossRefPubMed

50.

Miyazaki T, Uchida K, Sato M, Watanabe S, Yoshida A, Wada M, Shimada S, Kuiper JH, Baba H (2012) Knee laxity after staircase exercise predicts radiographic disease progression in medial compartment knee osteoarthritis. Arthritis Rheum 64(12):3908–3916. https://doi.org/10.1002/art.34662CrossRefPubMed

51.

Stäubli HU, Schatzmann L, Brunner P, Rincón L, Nolte LP (1996) Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults. Knee Surg Sports Traumatol Arthrosc 4:100–110CrossRefPubMed

52.

Fulkerson JP, Langeland R (1995) An alternative cruciate reconstruction graft: the central quadriceps tendon. Arthroscopy 11:252–254CrossRefPubMed

53.

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(2):249–262. https://doi.org/10.1016/j.ocl.2009.12.009CrossRefPubMed

54.

Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31(4):564–573. https://doi.org/10.1177/03635465030310041501CrossRefPubMed

55.

Walden M, Hagglund M, Magnusson H, Ekstrand J (2011) Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc 19(1):11–19. https://doi.org/10.1007/s00167-010-1170-9CrossRefPubMed

56.

Ardern CL, Webster KE, Taylor NF, Feller JA (2010) Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy 26(4):462–469. https://doi.org/10.1016/j.arthro.2009.08.018CrossRefPubMed

57.

Burks RT, Crim J, Fink BP, Boylan DN, Greis PE (2005) The effects of semitendinosus and gracilis harvest in anterior cruciate ligament reconstruction. Arthroscopy 21(10):1177–1185. https://doi.org/10.1016/j.arthro.2005.07.005CrossRefPubMed

58.

Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M, Mitsuoka T, Toritsuka Y, Hamada M, Shino K (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18(6):598–602CrossRefPubMed

59.

Keays SL, Bullock-Saxton J, Keays AC, Newcombe P (2001) Muscle strength and function before and after anterior cruciate ligament reconstruction using semitendonosus and gracilis. Knee 8(3):229–234CrossRefPubMed

60.

Renstrom P, Arms SW, Stanwyck TS, Johnson RJ, Pope MH (1986) Strain within the anterior cruciate ligament during hamstring and quadriceps activity. Am J Sports Med 14(1):83–87. https://doi.org/10.1177/036354658601400114CrossRefPubMed

61.

Withrow TJ, Huston LJ, Wojtys EM, Ashton-Miller JA (2008) Effect of varying hamstring tension on anterior cruciate ligament strain during in vitro impulsive knee flexion and compression loading. J Bone Joint Surg Am 90(4):815–823. https://doi.org/10.2106/JBJS.F.01352CrossRefPubMedPubMedCentral

62.

Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17(7):705–729. https://doi.org/10.1007/s00167-009-0813-1CrossRefPubMed

63.

Kremen TJ, Polakof LS, Rajaee SS, Nelson TJ, Metzger MF (2018) The effect of hamstring tendon autograft harvest on the restoration of knee stability in the setting of concurrent anterior cruciate ligament and medial collateral ligament injuries. Am J Sports Med 46(1):163–170. https://doi.org/10.1177/0363546517732743CrossRefPubMed

Title: Quadriceps tendon autograft for primary ACL reconstruction: a Bayesian network meta-analysis
Authors: Filippo Migliorini
Jörg Eschweiler
Yasser El Mansy
Valentin Quack
Markus Tingart
Arne Driessen
Publication date: 01-10-2020
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 7/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-020-02680-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Quadriceps tendon autograft for primary ACL reconstruction: a Bayesian network meta-analysis

Abstract

Background

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Material and methods

Results

Conclusion

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