title: Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years.
abstract: BACKGROUND
  The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft.
  
  
  OBJECTIVE
  The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test.
  
  
  RESULTS
  Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength.
  
  
  CONCLUSIONS
  The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.
authors.affiliation: Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.|Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Cavaignac
authors.affiliation: Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.|Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Benoit
authors.initials: B
authors.lastname: Coulin
authors.affiliation: Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.|Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Tscholl
authors.affiliation: Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.|Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Nik
authors.initials: N
authors.lastname: Nik Mohd Fatmy
authors.affiliation: Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.|Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Victoria
authors.initials: V
authors.lastname: Duthon
authors.affiliation: Sports Medicine Center, Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.|Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Jacques
authors.initials: J
authors.lastname: Menetrey
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects / Q000379:methods*; D001265:Athletic Injuries / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D000070632:Hamstring Tendons / Q000637:transplantation*; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000209:etiology; D011183:Postoperative Complications; D012086:Reoperation; D013710:Tendons / Q000637:transplantation*; D013848:Thigh; D014182:Transplantation, Autologous
keywords: anterior cruciate ligament; quadriceps tendon; sports medicine