Patient-Reported Outcomes and Revision Rates After ACL Reconstruction With Quadriceps Versus Hamstring and Patellar...

Quadriceps tendon (QT) autografts are increasingly used worldwide in anterior cruciate ligament (ACL) reconstruction (ACLR). However, comparative outcome studies across graft types, particularly by sex, remain limited.

To compare patient-reported outcomes (PROs) and revision rates after primary ACLR with QT autografts in relation to patellar tendon (PT) and hamstring tendon (HT) autografts, stratified by sex.

Cohort study; Level of evidence, 3.

Patients who underwent primary ACLR (2008-2022) were identified in the Swedish Knee Ligament Registry. The primary outcome was 2-year patient-reported knee function, assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Clinical relevance was evaluated using the KOOS4 (mean of KOOS Pain, Symptoms, Sports/Recreation, and Quality of Life subscales), with thresholds for minimal important change (MIC, ≥9), patient acceptable symptom state (PASS, ≥79), and treatment failure (TF, ≤42). Adjusted logistic regression analyses assessed factors associated with MIC, PASS, and TF. The secondary outcome was 2-year revision ACLR, reported as rates and analyzed using Cox regression to estimate hazard ratios.

A total of 18,920 patients (44%) had 2-year KOOS data available. Women receiving QT grafts had a lower proportion of MICs achieved than those with HT grafts (61% vs 71%; P = .027). Among men, PASS was more frequently achieved with QT (51%) and HT grafts (48%) than with PT grafts (40%) (both P≤ .030). In the regression analyses, women with HT grafts had higher odds of achieving MIC (odds ratio [OR], 1.69 [95% CI, 1.19-2.42]; P = .004) and PASS (OR, 1.81 [95% CI, 1.28-2.58]; P < .001), and lower odds of TF (OR, 0.53 [95% CI, 0.31-0.88]; P = .015) compared with QT grafts. Additionally, no significant differences were observed between QT and PT grafts in women or among graft types in men.Of 44,513 patients, 1019 (2.3%) underwent revision ACLR within 2 years: QT graft, 2.2% (28/1274); PT graft, 2.5% (50/2019); and HT graft, 2.3% (941/41,220) (P = .830). QT revision rates were 2.7% in women and 1.8% in men (P = .288). Graft type was not associated with revision hazard in adjusted Cox regression.

QT autografts were associated with lower PROs compared with HT autografts in women, whereas no such differences were observed when compared with PT autografts or among men. Revision rates were similar across graft types, both overall and by sex.