No Difference in Complication Rates or Patient-Reported Outcomes Between Bone-Patella Tendon-Bone and Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction

Daniel W Hogan; M Benjamin Burch; Joseph M Rund; Derek W Geeslin; Richard Ma; Aaron F Gray; Constance R Chu; Taylor E Ray; W Michael Pullen; Seth L Sherman

doi:10.1016/j.asmr.2021.10.019

No Difference in Complication Rates or Patient-Reported Outcomes Between Bone-Patella Tendon-Bone and Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction

Arthrosc Sports Med Rehabil. 2021 Dec 16;4(2):e417-e424. doi: 10.1016/j.asmr.2021.10.019. eCollection 2022 Apr.

Authors

Affiliations

¹ School of Medicine, University of Missouri, Columbia, Missouri.
² Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
³ Department of Orthopaedic Surgery, Stanford University, Palo Alto, California, U.S.A.

Abstract

Purpose: To compare subjective outcomes and complications of anterior cruciate ligament reconstruction (ACLR) using either bone-patellar tendon-bone (BPTB) or quadriceps tendon (QT) autograft.

Methods: A retrospective analysis of prospectively collected data identified consecutive cohorts of patients undergoing ACLR with either BPTB or QT autograft. Patients with less than 12-month follow-up and those undergoing concomitant osteotomies, cartilage restoration, and/or other ligament reconstruction procedures were excluded. Pre- and postsurgical patient-reported outcomes including International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, Tegner, and Marx were compared between groups. Complications requiring reoperation were recorded.

Results: One hundred nineteen patients met inclusion criteria, including 39 QT autografts and 80 BPTB autografts. Demographic information was comparable between groups. Mean follow-up was comparable between groups (QT 22.4 ± 10.6 months vs BPTB 28.5 ± 18.5 months, P = .06). At minimum 12-month follow-up (range 12.0-100.8 months), patients in both groups demonstrated statistically significant improvements in International Knee Documentation Committee (QT 60.0%, P < .0001; BPTB 57.7%, P < .0001), all Knee Injury and Osteoarthritis Outcome Score domains, PROMIS Mobility T-Score (QT 27.2%, P = .0001; BPTB 23.2%, P < .0001), PROMIS Global Physical Health (QT 14.4%, P = .002; BPTB 13.4%, P = .001), PROMIS Physical Function (QT 29.6%, P < .0001; BPTB 37.1%, P < .0001), PROMIS Pain Interference (QT -16.5%, P < .0001; BPTB -20.8%, P < .0001), Single Assessment Numeric Evaluation, (QT 76.9%, P < .0001; BPTB 73.3%, P < .0001), Tegner (QT 92.9%, P = .0002; BPTB 101.4%, P < .0001), and Marx (QT -26.6%, P = .02; BPTB -32.0%, P = .0002) with no statistically significant differences between the 2 groups. Overall postoperative reoperation rate did not differ between groups (QT 12.8% vs BPTB 23.8%, P = .2). Revision ACL reconstruction rate did not differ between groups (QT 5.1% vs BPTB 7.5%, P = .6).

Conclusions: Patients undergoing autograft ACLR with either BPTB or QT demonstrated significant subjective improvements in patient-reported outcomes from preoperative values and no statistically significant differences in outcomes between the groups. Complication and revision ACLR rates were similar between the 2 groups.

Level of evidence: III, retrospective cohort study.