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Primary Versus Revision ACL Reconstruction Using Quadriceps Autograft: A Matched-Control Cohort Study
Amit Meena1,2, Luca Farinelli3, Christian Hoser1,2
1Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Center of Excellence, Innsbruck, Austria.
Orthopaedic Journal of Sports Medicine
|February 5, 2024
Summary
Quadriceps tendon (QT) autograft shows acceptable functional outcomes for both primary and revision anterior cruciate ligament (ACL) reconstruction. However, revision ACL surgery with QT autograft had higher graft failure rates and more concomitant injuries than primary ACL reconstruction.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- The incidence of anterior cruciate ligament (ACL) reconstruction is rising globally.
- Quadriceps tendon (QT) autograft is increasingly utilized for both primary and revision ACL reconstructions.
- This study investigates the comparative outcomes of QT autograft in primary versus revision ACL surgery.
Purpose of the Study:
- To compare patient-reported functional outcomes between primary and revision ACL reconstruction using QT autograft.
- To evaluate differences in concomitant injuries associated with primary versus revision ACL reconstruction.
- To assess graft failure rates in primary versus revision ACL reconstruction utilizing QT autograft.
Main Methods:
- A retrospective cohort study (Level of evidence, 3) analyzed 376 primary and 138 revision ACL reconstructions from a prospectively collected registry.
- Patients underwent minimally invasive QT autograft harvesting with identical surgical and rehabilitation protocols.
- Cohorts were matched for age, sex, and pre-injury outcome scores (Lysholm, Tegner, VAS pain) with 2-year postoperative follow-up.
Main Results:
- Both groups showed significant improvements in Lysholm and VAS pain scores post-surgery.
- The primary ACL reconstruction group had higher rates of concomitant medial collateral ligament injuries.
- The revision group exhibited significantly more concomitant cartilage and meniscal injuries, and a higher graft failure rate (13.0% vs 5.6%).
Conclusions:
- Quadriceps tendon autograft provides acceptable functional outcomes for both primary and revision ACL reconstruction.
- Revision ACL reconstruction with QT autograft is associated with poorer outcomes, potentially due to a higher prevalence of associated meniscal and cartilage injuries.
- QT autograft is a viable option for both primary and revision ACL reconstruction, though careful patient selection and management of concomitant injuries are crucial in revision cases.
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