Quadriceps Tendon Autograft Produces Favorable Return to Sport, Strength, Range of Motion, Retear Rate, and Midterm...

To determine the outcomes of anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) graft with a minimum of 5-year follow-up.

A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane, Embase, and Medline databases were searched for studies published through May 2025. Inclusion criteria were studies that included ACLR with QT autograft with a minimum of 5-year follow-up. Studies investigating anterior cruciate ligament repairs and studies that did not separate analyses by graft type were excluded. Non-English studies, systematic reviews, technical notes, letters to the editor, and surgical technique papers were also excluded. Risk of bias was assessed using Joanna Briggs Institute's Methodological Quality Assessment Tool. Outcomes of interest included strength, range of motion (ROM), hop tests, joint laxity, patient-reported outcomes, return to sport, and complications.

Eight heterogeneous studies including 662 ACLRs utilizing QT graft with follow-ups ranging from 5 to 23 years were included in this review. Favorable outcomes reported in these studies included strength, ROM, hopping, joint laxity, patient-reported outcomes, return to sport, and complications. The complication rates ranged from 0% to 24% for graft failure, 3% to 35.3% for ipsilateral reoperations for reasons other than graft failure, 5.4% to 23.5% for contralateral ACLR, 0% to 11.5% for patients with donor graft site pain, 0% to 5% for anterior knee pain, and 0% to 1.5% for infection.

Overall, this systematic review has shown that the QT graft produces good midterm outcomes and is a viable graft choice for patient strength, joint laxity, return to sport, ROM, and patient-reported outcomes. This study found higher rates of graft failure and ROM deficits but lower rates of anterior knee pain compared with studies examining outcomes of ACLR with QT graft with a minimum 2-year follow-up supporting the need for longer outcome studies to further define the longevity of the QT graft.

Level IV, systematic review of Level II to IV studies.