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The Quadriceps Tendon: The Forgotten graft?

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1 The Quadriceps Tendon: The Forgotten graft?
Systematic Review of Primary ACL Reconstruction utilising Autograft Quadriceps Tendon S Hutchinson, J Mulford

2 Quadriceps tendon had increased interest in recent times as a graft for primary ACL surgery.
We wanted to know the outcomes utilising this graft when compared to traditional autografts

3 Technique

4 Aim Clarify the outcomes with use of the quadriceps tendon in primary ACL surgery. Systematic review process was utilised.

5 Proposed Benefits of Quads Graft
Thicker tendon cf patella tendon Ability to be consistently used as a double bundle graft Provides bone healing on one side Less anterior knee pain cf patella tendon Less stretching cf hamstring tendon

6 Method A search process utilising: MEDLINE ( ), EMBASE ( ), CINAHL, Google search engine. Review of references of all articles identified in the search.

7 Inclusion and Exclusion Criteria
Inclusion criteria 1. Original articles with patients with primary ACL rupture treated with a quadriceps tendon autograft. 2. Articles which reported on one or more of the primary outcomes. Exclusion Criteria 1. Articles which did not document minimum length of patient follow-up. 2. Studies with less than 12 months of patient follow-up. 3. Duplicate publication of any type, for example abstracts, comments, review or technique articles, duplicate reports and articles based on preliminary data from larger series.

8 Pre Determined Outcomes
Subjective Anterior/patellofemoral/ kneeling pain patient satisfaction. Objective Range of motion (flexion loss or extension loss > 5 degrees) Lachman Grade, pivot shift grade IKDC score KT-1000 return to pre-injury level, muscle strength (flexion and extension strength), Lysholm score surgery complications (Specifically graft rupture or failure, patella fracture and infection).

9 Data extracted independently by two reviewers
Recorded Methodology predetermined outcome measures

10 Results Initial search identified 45 article for review
16 articles met the inclusion criteria 4 articles compared graft types 3 patella tendon vs QT; 1 hamstrings

11 Comparison Articles 3 compared PT to Quads 1 compared Quads to HT
Poor methodology and variability in reporting of outcomes No real difference except Anterior Knee Pain 43 of 114 (38%) in patella tendon 12 of 108 (11%) in quadriceps group

12 All Articles All retrospective studies 1539 grafts

13 Subjective Outcomes Patient satisfaction: 91% (303 of 332)
Anterior knee pain: 3% (22 of 699)

14 Objective Outcomes Lachmann grade >1: 7% (52 of 684)
Pivot Shift grade > 1: 8% (41 of 534) IKDC score A or B: % (592 of 676) Lysholm Score: Acceptable post op outcomes (89-94) Fixed flexion > 5 degrees % (27 of 730) Quads strength (<80%): of 398

15 Complications Graft failure: % (21 of 666) Patella fracture: 5

16 Conclusion The quadriceps tendon is a viable alternative to traditional autografts. Anterior knee pain is less for quadriceps graft compared to patella tendon grafts. Thus our goal to set up a randomised trial

17 Stephen Hutchinson Jonathan Mulford
Thankyou Stephen Hutchinson Jonathan Mulford

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