No Postoperative Difference Between Bone-Block Versus All-Soft Tissue Quadriceps Tendon Autografts for Anterior...

Quadriceps tendon autografts are increasingly used for anterior cruciate ligament reconstruction (ACLR), harvested either with a patellar bone block (quadriceps tendon bone block [QTBB]) or as an all-soft tissue graft (quadriceps tendon soft tissue [QTST]). However, comparative data on outcomes remain limited and heterogeneous.

It was hypothesized that there would be no significant differences in patient-reported outcomes, objective stability, return to sports, or complication rates between QTBB and QTST grafts used for primary ACLR.

Systematic review and meta-analysis; Level of evidence, 4.

A systematic review of 4 databases (PubMed, Embase, Scopus, and SportDISCUS) was conducted through November 2024. Studies reporting outcomes after primary ACLR using QTBB or QTST autografts were included (Levels 1-4 evidence). Random-effects meta-analyses pooled outcomes for each graft; meta-regression compared grafts while adjusting for follow-up duration and publication year. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

A total of 44 studies (n = 2083; QTBB = 1104; QTST = 979) met the inclusion criteria with a mean follow-up of 29 months. International Knee Documentation Committee scores averaged 79.7 (95% CI, 74.8-84.6) for QTBB and 85.4 (95% CI, 80.9-89.8) for QTST autografts (β = 5.2; P = .11). There were no significant between-group differences in Lysholm, Tegner, or Knee injury and Osteoarthritis Outcome Score subscale scores. Instrumented laxity (KT-1000/2000) was higher for QTBB (1.75 mm [1.30-2.21]) versus QTST grafts (0.50 mm [0.35-0.65]) (β = -1.25 mm; P = 0.087), although this difference was not statistically significant and QTST results were driven by a single high-volume cohort. No significant differences were found in Lachman, pivot-shift, or anterior drawer grades. Return to sports (RTS) rates were 82% for QTBB and 81% for QTST grafts (P = .82). Graft failure (both 6%), anterior knee pain (8% vs 7%), and infection (~1%) rates were comparable (all P > .70). Heterogeneity was high for patient-reported outcome measures (I² >75%) but low for complications. Most studies had a moderate risk of bias, and the certainty of evidence was graded as very low across outcomes due to inconsistency, imprecision, and the observational nature of included studies.

This systematic review and meta-analysis found no clinically meaningful differences in short-term patient-reported outcomes, graft integrity, RTS rates, or complications between QTBB and QTST grafts in primary ACLR.