Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2018

01-02-2018 | Knee

There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study

Authors: Armin Runer, Guido Wierer, Elmar Herbst, Caroline Hepperger, Mirco Herbort, Peter Gföller, Christian Hoser, Christian Fink

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2018

Login to get access

Abstract

Purpose

Graft choice for anterior cruciate ligament (ACL) reconstruction is crucial, however the optimal graft source remains a topic of controversy. The purpose of this study is to compare subjective and functional patient-reported outcomes (PRO) after single-bundle ACL reconstruction using quadriceps tendon (QT) or hamstring tendon (HT) autografts for single-bundle ACL reconstruction. We hypothesize that there is no difference in patient-reported functional outcomes after ACL reconstruction using either HT- or QT autograft.

Methods

All data were extracted from a prospectively collected ACL registry. A total of 80 patients with at least 2-year follow-up were included in this study. A total of 40 patients with primary ACL reconstruction using a QT autograft harvested via a minimally invasive technique were matched by sex, age and pre-injury Tegner and Lysholm score to 40 patients who received HT autografts. Subjective and functional PRO scores including Lysholm score, Tegner activity level and visual analogue scale for pain were obtained at 6, 12 and 24 months after index surgery.

Results

No significant difference between the QT and the HT group was seen at any follow-up in regard to any of the PRO scores for function or pain. 24 months post-surgery the mean Tegner activity score of the HT group was significantly (p = 0.04) lower compared to the pre-injury status. At final follow-up, 27 patients (67.5%) in the QT group and 32 patients (80.0%) in the HT returned to their pre-injury activity level (n.s.). A total of 37 patients (92.5%) of the QT cohort and 35 patients (87.5%) of the HT cohort reported “good” or “excellent” results according to the Lysholm score (n.s.). “No pain” or “slight pain” during severe exertion was reported by 33 patients (82.5%) with QT autograft and 28 patients (82.4%) with HT autograft (n.s.).

Conclusion

There is no significant difference between PRO 2 years post-operative using either QT or HT autografts. Both QT and HT grafts show acceptable and comparable PRO scores making the QT a reliable graft alternative to HT for primary ACL reconstruction.

Level of evidence

III.
Literature
1.
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):890–897CrossRefPubMed
2.
Briggs KK, Steadman JR, Hay CJ, Hines SL (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37(5):898–901CrossRefPubMed
3.
4.
Chen CH, Chuang TY, Wang KC, Chen WJ, Shih CH (2006) Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft: clinical outcome in 4–7 years. Knee Surg Sports Traumatol Arthrosc 14(11):1077–1085CrossRefPubMed
5.
DeAngelis JP, Fulkerson JP (2007) Quadriceps tendon—a reliable alternative for reconstruction of the anterior cruciate ligament. Clin Sports Med 26(4):587–596CrossRefPubMed
6.
Eriksson K, Anderberg P, Hamberg P, Lofgren AC, Bredenberg M, Westman I, Wredmark T (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83(3):348–354CrossRefPubMed
7.
Fink C, Herbort M, Abermann E, Hoser C (2014) Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthrosc Tech 3(4):e509–e513CrossRefPubMedPubMedCentral
8.
Geib TM, Shelton WR, Phelps RA, Clark L (2009) Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy 25(12):1408–1414CrossRefPubMed
9.
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):1284–1292CrossRefPubMed
10.
Group M, Group M (2014) Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Am J Sports Med 42(10):2301–2310CrossRef
11.
Gulotta LV, Rodeo SA (2007) Biology of autograft and allograft healing in anterior cruciate ligament reconstruction. Clin Sports Med 26(4):509–524CrossRefPubMed
12.
Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81(4):549–557CrossRefPubMed
13.
Han HS, Seong SC, Lee S, Lee MC (2008) Anterior cruciate ligament reconstruction: quadriceps versus patellar autograft. Clin Orthop Relat Res 466(1):198–204CrossRefPubMedPubMedCentral
14.
Harris NL, Smith DA, Lamoreaux L, Purnell M (1997) Central quadriceps tendon for anterior cruciate ligament reconstruction. Part I: morphometric and biomechanical evaluation. Am J Sports Med 25(1):23–28CrossRefPubMed
15.
Herbort M, Michel P, Raschke MJ, Vogel N, Schulze M, Zoll A, Fink C, Petersen W, Domnick C (2016) Should the ipsilateral hamstrings be used for anterior cruciate ligament reconstruction in the case of medial collateral ligament insufficiency? Am J Sports Med 10(1177/0363546516677728):363546516677728
16.
Herbort M, Tecklenburg K, Zantop T, Raschke MJ, Hoser C, Schulze M, Petersen W, Fink C (2013) Single-bundle anterior cruciate ligament reconstruction: a biomechanical cadaveric study of a rectangular quadriceps and bone–patellar tendon–bone graft configuration versus a round hamstring graft. Arthroscopy 29(12):1981–1990CrossRefPubMed
17.
Herrington L (2013) Functional outcome from anterior cruciate ligament surgery: a review. OA Orthop 1(2):1–12CrossRef
18.
Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon–bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38(3):448–454CrossRefPubMed
19.
Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA (2005) Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 21(4):412–417CrossRefPubMed
20.
Imran A, O’Connor JJ (1998) Control of knee stability after ACL injury or repair: interaction between hamstrings contraction and tibial translation. Clin Biomech (Bristol, Avon) 13(3):153–162CrossRef
21.
Keays SL, Bullock-Saxton JE, Keays AC, Newcombe PA, Bullock MI (2007) A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction: patellar tendon versus semitendinosus and Gracilis tendon graft. Am J Sports Med 35(5):729–739CrossRefPubMed
22.
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):137–144CrossRefPubMed
23.
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):166–172CrossRefPubMed
24.
Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32(3):629–634CrossRefPubMed
25.
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):2323–2329CrossRefPubMed
26.
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):116–126PubMed
27.
Lee S, Seong SC, Jo H, Park YK, Lee MC (2004) Outcome of anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthroscopy 20(8):795–802CrossRefPubMed
28.
Liden M, Ejerhed L, Sernert N, Laxdal G, Kartus J (2007) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-year follow-up. Am J Sports Med 35(5):740–748CrossRefPubMed
29.
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):593–598CrossRefPubMed
30.
Mae T, Shino K, Matsumoto N, Maeda A, Nakata K, Yoneda M (2010) Graft tension during active knee extension exercise in anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 26(2):214–222CrossRefPubMed
31.
Magnussen RA, Carey JL, Spindler KP (2011) Does autograft choice determine intermediate-term outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 19(3):462–472CrossRefPubMed
32.
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):321–331CrossRefPubMed
33.
34.
More RC, Karras BT, Neiman R, Fritschy D, Woo SL, Daniel DM (1993) Hamstrings—an anterior cruciate ligament protagonist. An in vitro study. Am J Sports Med 21(2):231–237CrossRefPubMed
35.
Mulford JS, Hutchinson SE, Hang JR (2013) Outcomes for primary anterior cruciate reconstruction with the quadriceps autograft: a systematic review. Knee Surg Sports Traumatol Arthrosc 21(8):1882–1888CrossRefPubMed
36.
Noyes FR, Barber-Westin SD (2006) Anterior cruciate ligament revision reconstruction: results using a quadriceps tendon–patellar bone autograft. Am J Sports Med 34(4):553–564CrossRefPubMed
37.
Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS (1984) Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 66(3):344–352CrossRefPubMed
38.
Otsuka H, Ishibashi Y, Tsuda E, Sasaki K, Toh S (2003) Comparison of three techniques of anterior cruciate ligament reconstruction with bone–patellar tendon–bone graft. Differences in anterior tibial translation and tunnel enlargement with each technique. Am J Sports Med 31(2):282–288CrossRefPubMed
39.
Paessler HH, Mastrokalos DS (2003) Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon–graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin N Am 34(1):49–64CrossRef
40.
Renstrom PA (2013) Eight clinical conundrums relating to anterior cruciate ligament (ACL) injury in sport: recent evidence and a personal reflection. Br J Sports Med 47(6):367–372CrossRefPubMed
41.
Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M (2005) A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med 33(9):1337–1345CrossRefPubMed
42.
Sajovic M, Vengust V, Komadina R, Tavcar R, Skaza K (2006) A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med 34(12):1933–1940CrossRefPubMed
43.
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):723–730CrossRefPubMedPubMedCentral
44.
Schulz AP, Lange V, Gille J, Voigt C, Frohlich S, Stuhr M, Jurgens C (2013) Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months. Open Access J Sports Med 4:243–249CrossRefPubMedPubMedCentral
45.
Shaieb MD, Kan DM, Chang SK, Marumoto JM, Richardson AB (2002) A prospective randomized comparison of patellar tendon versus semitendinosus and gracilis tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 30(2):214–220CrossRefPubMed
46.
Shelton WR, Fagan BC (2011) Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 19(5):259–264CrossRefPubMed
47.
Slone HS, Romine SE, Premkumar A, Xerogeanes JW (2015) Quadriceps tendon autograft for anterior cruciate ligament reconstruction: a comprehensive review of current literature and systematic review of clinical results. Arthroscopy 31(3):541–554CrossRefPubMed
48.
Smigielski R, Zdanowicz U, Drwiega M, Ciszek B, Ciszkowska-Lyson B, Siebold R (2015) Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees. Knee Surg Sports Traumatol Arthrosc 23(11):3143–3150CrossRefPubMed
49.
Staubli HU, Schatzmann L, Brunner P, Rincon L, Nolte LP (1996) Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults. Knee Surg Sports Traumatol Arthrosc 4(2):100–110CrossRefPubMed
50.
Staubli HU, Schatzmann L, Brunner P, Rincon L, Nolte LP (1999) Mechanical tensile properties of the quadriceps tendon and patellar ligament in young adults. Am J Sports Med 27(1):27–34CrossRefPubMed
51.
Xerogeanes JW, Mitchell PM, Karasev PA, Kolesov IA, Romine SE (2013) Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement. Am J Sports Med 41(10):2392–2399CrossRefPubMed
52.
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):1060–1069CrossRefPubMed
Metadata
Title
There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study
Authors
Armin Runer
Guido Wierer
Elmar Herbst
Caroline Hepperger
Mirco Herbort
Peter Gföller
Christian Hoser
Christian Fink
Publication date
01-02-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4554-2

Other articles of this Issue 2/2018

Knee Surgery, Sports Traumatology, Arthroscopy 2/2018 Go to the issue

Knee

Superior return to sports rate after patellar tendon autograft over patellar tendon allograft in revision anterior cruciate ligament reconstruction

Knee

Improvement in the medial meniscus posterior shift following anterior cruciate ligament reconstruction

Knee

High incidence of partially anatomic tunnel placement in primary single-bundle ACL reconstruction

Knee

Superior perioperative analgesia with combined femoral–obturator–sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery

Knee

ACL suturing using dynamic intraligamentary stabilisation showing good clinical outcome but a high reoperation rate: a retrospective independent study

Knee

Patient satisfaction with health is substantially improved following ACL reconstruction