title: Is quadriceps tendon a better graft choice than patellar tendon? a prospective randomized study.
abstract: OBJECTIVE
  The purpose of this randomized controlled study was to compare knee stability, kneeling pain, harvest site pain, sensitivity loss, and subjective clinical outcome after primary anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) or quadriceps tendon-bone (QTB) autografts in a noninferiority study design.
  
  
  METHODS
  From 2005 to 2009, a total of 51 patients were included in the present study. Inclusion criteria were isolated ACL injuries in adults. Twenty-five patients were randomized to BPTB grafts and 26 to QTB grafts. An independent examiner performed follow-up evaluations 1 and 2 years postoperatively. Anteroposterior knee laxity was measured with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Anterior knee pain was assessed clinically and by knee-walking ability. Knee Injury and Osteoarthritis Outcome Score (KOOS) and subjective International Knee Documentation Committee (IKDC) score were used for patient-evaluated outcome.
  
  
  RESULTS
  Anterior knee laxity was equal between the 2 groups with KT-1000 values of 1.1 ± 1.4 mm and 0.8 ± 1.7 mm standard deviation (SD) at follow-up in QTB and BPTB groups, respectively (P = .65), whereas positive pivot shift test results were seen less frequently (14% compared with 38%, respectively; P = .03). Anterior kneeling pain, evaluated by the knee walking ability test, was significantly less in the QTB group, with only 7% of patients grading knee walking as difficult or impossible compared with 34% in the BPTB group. At 1 and 2 years' follow-up, there was no difference between the 2 groups in subjective patient-evaluated outcome. The IKDC score was 75 ± 13 patients and 76 ± 16 SD at 1-year follow-up in QTB and BPTB groups, respectively (P = .78). At 2 years, 12 patients were lost to follow-up, resulting in 18 in the BPTB group and 21 in the QTB group.
  
  
  CONCLUSIONS
  The use of the QTB graft results in less kneeling pain, graft site pain, and sensitivity loss than seen with BPTB grafts; however, similar anterior knee stability and subjective outcomes are seen. The results of this study show that QTB is a viable option for ACL reconstruction.
  
  
  METHODS
  Level II, randomized controlled clinical trial.
authors.affiliation: Division of Sports Trauma, University Hospital of Aarhus, Aarhus, Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Lund
authors.affiliation: Division of Sports Trauma, University Hospital of Aarhus, Aarhus, Denmark.
authors.forename: Torsten
authors.initials: T
authors.lastname: Nielsen
authors.affiliation: Division of Sports Trauma, University Hospital of Aarhus, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Faunø
authors.affiliation: Division of Sports Trauma, University Hospital of Aarhus, Aarhus, Denmark.
authors.forename: Svend Erik
authors.initials: SE
authors.lastname: Christiansen
authors.affiliation: Division of Sports Trauma, University Hospital of Aarhus, Aarhus, Denmark. Electronic address: martinlind@dadlnet.dk.
authors.forename: Martin
authors.initials: M
authors.lastname: Lind
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods* / Q000534:rehabilitation; D018771:Arthralgia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000637:transplantation*; D063372:Physical Therapist Assistants; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000637:transplantation; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D055815:Young Adult