4 AimClarify 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 tendonAbility to be consistently used as a double bundle graftProvides bone healing on one sideLess anterior knee pain cf patella tendonLess stretching cf hamstring tendon
6 MethodA 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 criteria1. 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 Criteria1. 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 SubjectiveAnterior/patellofemoral/ kneeling painpatient satisfaction.ObjectiveRange of motion (flexion loss or extension loss > 5 degrees)Lachman Grade, pivot shift gradeIKDC scoreKT-1000return to pre-injury level,muscle strength (flexion and extension strength),Lysholm scoresurgery complications (Specifically graft rupture or failure, patella fracture and infection).
9 Data extracted independently by two reviewers RecordedMethodologypredetermined outcome measures
10 Results Initial search identified 45 article for review 16 articles met the inclusion criteria4 articles compared graft types3 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 outcomesNo real difference exceptAnterior Knee Pain43 of 114 (38%) in patella tendon12 of 108 (11%) in quadriceps group
12 All ArticlesAll retrospective studies1539 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 ComplicationsGraft failure: % (21 of 666)Patella fracture: 5
16 ConclusionThe 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 ThankyouStephen HutchinsonJonathan Mulford