Related Experiment Video
Updated: Mar 7, 2026
Harvesting of Peroneus Longus Tendon Autograft
Published on: September 2, 2025
Differences in Graft Rupture and Subsequent Meniscal Tears Following Adolescent ACL Reconstruction Using Quadriceps
Morgan E Swanson1,2, Christopher DeFrancesco1,3, Kevin M Landrum1,4
1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Background:
Anterior cruciate ligament (ACL) reconstruction (ACLR) using quadriceps tendon (QT) autograft is associated with lower rates of graft rupture and favorable functional outcomes compared with hamstring (HS) autograft in adolescents. The ACL-deficient knee is at increased risk of injury to secondary stabilizers of the knee, including the menisci, although studies have not reported differences in rates of subsequent meniscal tear between HS and QT groups.
Purpose:
The goal of this study was to compare rates of graft rupture and subsequent meniscal tear after adolescent ACLR using HS or QT autograft.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
This was a retrospective review of adolescent patients (age, 10-19 years) who underwent ACLR with either HS or QT autograft between 2009 and 2023 at an urban tertiary care pediatric hospital. Patients with ≥2 years of clinical follow-up were included. Patient characteristics, surgical details, and reinjury rates were calculated and compared between the 2 subgroups. Multivariable logistic regression was performed to evaluate the relationship between graft failure and relevant variables.
Results:
A total of 467 patients (52.0% female) with mean age 14.6 ± 1.9 years and median follow-up of 3.1 (range, 2.0-13.4) years were included. The QT subgroup more commonly underwent concomitant anterolateral ligament reconstruction/lateral extra-articular tenodesis at the time of primary ACLR (P < .001), were slightly older (P = .04), had higher baseline body mass index (P = .01), had a shorter period of follow-up (P < .001), and more commonly had concomitant medial meniscal tear compared with the HS group (P = .047). Graft rupture was lower among patients treated with QT versus HS (7.2% vs 23.2%; P < .001). The rate of subsequent meniscal tear was not statistically significantly different among patients treated with QT versus HS (4.6% vs 9.2%, respectively; P = .08). Regression analysis showed that graft type was associated with risk of graft failure (QT vs HS: odds ratio, 0.29; P < .001) but was not clearly associated with subsequent meniscal tear (QT vs HS: odds ratio, 0.47; P = .09).
Conclusion:
Adolescent patients undergoing ACLR with QT autograft have significantly lower risk of graft rupture compared with those treated with HS autograft. There was no statistically significant difference in rate of subsequent meniscal tear between the QT and HS groups.
