Quadriceps Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction Has No Difference in Short-Term Clinical Outcomes Between All-Soft Tissue Versus Tendon-Bone Grafts: A Systematic Review.

Purpose

To compare clinical outcomes and complications after primary anterior cruciate ligament reconstruction with all-soft tissue quadriceps tendon (ST-QT) versus quadriceps tendon-bone (QT-B) autograft.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, Embase, and Cochrane Library to identify studies directly comparing outcomes of primary anterior cruciate ligament reconstruction with ST-QT versus QT-B autograft. Outcomes included rates of graft failure and other complications, patient-reported outcomes, return to sport, anteroposterior knee laxity, pivot shift testing, and the Objective International Knee Documentation Committee score.

Results

Five studies (1 Level II, 4 Level III) met the inclusion criteria, including a total of 996 knees undergoing anterior cruciate ligament reconstruction with ST-QT autograft and 1279 with QT-B autograft. Mean age at surgery ranged from 20.3 to 31.7 years. Minimum follow-up time ranged from 12.0 to 24.0 months. The overall percentage of men ranged from 48.8% to 84.6%. Graft failure ranged from 2.4% to 7.6% of patients in the ST-QT autograft group and 3.3% to 6.4% in the QT-B autograft group. No study found a significant difference in graft failure rates between the 2 groups. Intraoperative patellar fracture occurred in 2 cases overall, both in the QT-B group. No studies found a significant difference in return to sport between groups. One study found significantly better Knee Injury and Osteoarthritis Outcome Score subscale scores in the ST-QT group. One study found a significantly greater proportion of ST-QT patients showing a positive pivot shift postoperatively. No other significant differences were found for the remaining patient-reported outcomes between groups.

Conclusions

Current comparative evidence suggests ST-QT and QT-B autografts for primary anterior cruciate ligament reconstruction yield similar short- to midterm outcomes, though limited studies and follow-up warrant cautious interpretation. Patellar fracture remains an uncommon QT-B risk. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies.