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Informasjon om prosjekttittel 'Incidence of revisions and outcomes after quadriceps graft versus bone-patellar-bone and hamstrings grafts in the Danish ACL Registry'

Incidence of revisions and outcomes after quadriceps graft versus bone-patellar-bone and hamstrings grafts in the Danish ACL Registry

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Prosjektstatus: Ongoing
Prosjektleder: Marc Strauss
Veileder(e): Lars Engebretsen, Gilbert Moatshe, Martin Lind


Background: The quadriceps tendon (QT) has recently gained interest as an anterior cruciate ligament (ACL) reconstruction autograft. There is a paucity of data on failures and revision rates of ACL reconstructions (ACLR) using the QT from large cohort studies.

Hypothesis/Purpose: To present and compare objective knee stability, subjective clinical outcomes, and revision rates of patients after ACLR with QT, hamstring tendon (STG), and patellar tendon (PT) autografts using the Danish Knee Ligament Reconstruction Registry (DKLR). We hypothesized that QT autografts would result in similar objective knee stability, and subjective clinical outcomes and revision rates as STG and PT autografts.

Study Design: Cohort study; Level of evidence, 3

Methods: Data onACLRs in the DKLR between 2005 and 2016 were analyzed. Sagittal knee laxity via the Knee Translation-1000 device, pivot-shift results, Knee Injury and Osteoarthritis Outcome Scores (KOOS), and Tegner activity scale scores at one-year follow-up and revision rates at two-year follow-up were used to compare the three autograft cohorts. 

Results: A total of 21,773 ACLRs were registered in the DKLR between 2005 and 2016. Significant higher revision rate for QT compared to PT and STG graft at two-year follow-up was found with revisions rates of 4.9%, 2.3%, and 1.6% for QT, STG, and PT ACLRs, respectively.

QT autograft use was associated with similar objective knee laxity compared to PT but significantly increased laxity compared to STG autograft use, producing 1.7 mm (QT), 1.6 mm (PT), and 1.5 mm (STG) of post-operative laxity, respectively (QT vs. PT p=0.13; QT vs. STG p=0.004). KOOS scores demonstrated improvement in all autograft cohorts (p<0.04), with STG autografts outperforming PT autografts (p<0.05). QT autografts produced a significantly higher KOOS Sport/Recreation sub-score than PT autografts (p=0.02), but a significantly lower Quality of Life sub-score than STG autografts (p=0.02). Tegner activity scale scores improved for all graft cohorts (p<0.0001).

Conclusion: QT autografts were associated with a higher revision rate and increased post-operative objective knee laxity than STG and PT. We do not conclude similar clinical outcomes for QT, STG, and PT ACLRs as hypothesized.