Patients Perceive Anterior Cruciate Ligament Reconstruction More Positively With Quadriceps Autograft Than With...

To analyze patient sentiment, experience, and perception differences between anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon autograft (QTG) and ACLR with bone-tendon-bone autograft (BTB).

Publicly accessible social media posts from 2012 to 2024 regarding ACLR were identified using a systematic keyword search strategy across major platforms. Posts containing information on patient experiences with QTG and BTB were extracted. First-order themes, sub-themes, and sentiment scores were assigned to each post by 2 independent reviewers. In addition, post characteristics such as platform of distribution, publication date, time after surgery, and sex of poster were recorded. Both inter-rater and intrarater reliability was assessed. Disagreements were settled with consensus discussions between the 2 raters. Descriptive statistics were used to summarize post characteristics, whereas χ² and one-way analysis of variance tests were used to compare outcomes between the two graft types.

We analyzed 531 posts pertaining to QTG and 507 posts pertaining to BTB. QTG posts were more often positive (61.7%) than BTB posts (42.6%), with fewer negative posts (8.9% vs 18.9%, P < .001). For both graft types, common first-order themes were functional outcomes (QTG, 50.6%; BTB, 45.2%), pain management (QTG, 40.8%; BTB, 48.5%), and recovery milestones (QTG, 51.5%; BTB, 39.1%). BTB posts more frequently referenced "scar formation" as a donor-site concern (P < .001). Thematic trends varied over time. Among QTG posts, discussion of recovery milestones increased from 34.9% in the early postoperative period (0-2 weeks) to 57.9% at more than 2 years. In contrast, this theme decreased among BTB posts over the same time frame (from 43.9% to 33.3%). Pain management themes declined over time for QTG posts (from 55.3% to 36.8%) but remained consistently high for BTB posts (from 54.4% to 47.7%).

Social media posts regarding QTG were more positive in nature when compared with posts on patellar tendon autograft. Common discussion topics within the publicly available, online orthopaedic patient community were also identified, including functional outcomes, pain management, and recovery milestones.

Social media can reflect patient sentiment regarding surgical options for ACLR. This study can therefore inform surgeons so that they can have more effective discussions with patients regarding autograft options.