Clinical outcomes after ACL reconstruction with free quadriceps tendon autograft versus hamstring tendons autograft. A retrospective study with a minimal follow-up two years

Background: It is unclear what the optimal graft choice is for performing anterior cruciate ligament (ACL) reconstruction in a skeletally immature patient. Purpose: To evaluate outcomes and complications of skeletally immature patients undergoing transphyseal ACL reconstruction with a hamstring tendon autograft versus a quadriceps tendon autograft. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2012 and 2016, 90 skeletally immature patients from a single institution underwent primary transphyseal ACL reconstruction with either a quadriceps tendon autograft or a hamstring tendon autograft based on surgeon preference (n = 3). Patient demographic, injury, radiographic, and surgical variables were documented. Outcome measures included the Lysholm score, Single Assessment Numeric Evaluation (SANE), Tegner activity score, pain, satisfaction, and complications such as graft tears and physeal abnormalities. Results: A total of 83 patients (56 hamstring tendon, 27 quadriceps tendon) were available for a minimum follow-up of 2 years or sustained graft failure. The mean age of the patients was 14.8 ± 1.4 years at the time of ACL reconstruction. No differences in chronological age, bone age, sex, patient size, or mechanism of injury were noted between groups. There were no differences in surgical variables, except that the quadriceps tendon grafts were larger than the hamstring tendon grafts (9.6 ± 0.6 mm vs 7.8 ± 0.7 mm, respectively; P < .001). Patient outcomes at a mean follow-up of 2.8 ± 0.9 years revealed no differences based on graft type, with mean Lysholm, SANE, pain, satisfaction, and Tegner scores of 96, 93, 0.6, 9.6, and 6.6, respectively, for the quadriceps tendon group and 94, 89, 0.9, 9.2, and 7.1, respectively, for the hamstring tendon group. While there were no physeal complications in either group, patients undergoing ACL reconstruction with a hamstring tendon autograft were more likely to tear their graft (21% vs 4%, respectively; P = .037). Conclusion: Skeletally immature patients undergoing ACL reconstruction can be successfully managed with either a quadriceps tendon autograft or a hamstring tendon autograft with good short-term outcomes, high rates of return to sport, and low rates of physeal abnormalities. The primary differences between grafts were that the quadriceps tendon grafts were larger and were associated with a lower retear rate. ACL reconstruction performed with a quadriceps tendon autograft may reduce early graft failure in skeletally immature patients.

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A Comparison of Two-Year ACL Reconstruction Clinical Outcomes Using All-Soft Tissue Quadriceps Tendon Autograft With Femoral/Tibial Cortical Suspensory Fixation Versus Tibial Interference Screw Fixation

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.06.024 ◽

2021 ◽

Author(s):

Dylan N. Greif ◽

Brandon J. Shallop ◽

Paul R. Allegra ◽

William H. Cade ◽

Kayla E. Minesinger ◽

...

Keyword(s):

Soft Tissue ◽

Clinical Outcomes ◽

Acl Reconstruction ◽

Screw Fixation ◽

Quadriceps Tendon ◽

Interference Screw ◽

Suspensory Fixation ◽

Interference Screw Fixation ◽

Tendon Autograft

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Quadriceps Tendon Autografts Have A Lower Early Graft Failure Rate Than Hamstring Tendon Autografts When Performing Transphyseal ACL Reconstructions

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00294 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0029

Author(s):

Andrew T. Pennock ◽

Kristina Parvanta Johnson ◽

Henry G. Chambers ◽

Tracey P. Bastrom ◽

Raghav Badrinath ◽

...

Keyword(s):

Acl Reconstruction ◽

Return To Sport ◽

Quadriceps Tendon ◽

Hamstring Tendon ◽

Skeletally Immature ◽

Hamstring Tendon Autograft ◽

Early Graft ◽

Tendon Grafts ◽

Tendon Autograft

Objectives: It is unclear what the optimal graft choice is for performing a transphyseal ACL reconstruction in a skeletally immature patient. The purpose of the current study was to evaluate outcomes and complications of skeletally immature patients undergoing an ACL reconstruction with hamstring tendon autograft versus quadriceps tendon autograft. Methods: Between 2012 and 2016, 104 skeletally immature patients from a single institution underwent a primary transphyseal ACL reconstruction with either quadriceps tendon autograft or hamstring tendon autograft based on surgeon preference. Patient demographic, injury, radiographic, and surgical variables were documented. Outcome measures included Lysholm score, SANE score, pain score, satisfaction, return to sport, and complications such as graft tears and physeal abnormalities. Results: Ninety patients (87%) including 62 hamstring tendon reconstructions and 28 quadriceps tendon reconstructions were available for a minimum follow-up of 2 years. The mean age of the patients was 14.8±1.3 years. No differences in chronologic age, bone age, gender, patient size, or mechanism of injury were noted between patient groups. There were no differences in surgical variables except the quadriceps tendon grafts were larger than the hamstring tendon grafts (9.6 mm vs 7.8 mm; p<0.001). Patient outcomes at a mean follow-up of 2.8 years revealed no differences based graft type with a mean Lysholm score, SANE score, pain score, satisfaction, and Tegner score were 95, 91, 0.8, 9.3, and 6.9 respectively. While there were no physeal complications in either group, patients undergoing a hamstring tendon autograft reconstruction were more likely to tear their graft (19% vs 0%; p= 0.01). Conclusion: Skeletally immature patients undergoing an ACL reconstruction can be successfully managed with either a quadriceps tendon autograft or a hamstring tendon autograft with good short-term outcomes, relatively high rates of return to sport, and low rates of physeal abnormalities. The primary differences between grafts were that the quadriceps tendon grafts were larger and were associated with a lower retear rate. Although a relatively new graft source for skeletally immature ACL reconstructions, the quadriceps tendon is not only a viable graft option, but it may be superior to the hamstrings tendon when it comes to early graft failures.

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Management of Complete Talocrural Luxations by Selective Talocrural Arthrodesis using Hybrid Transarticular External Skeletal Fixation in Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1651486 ◽

2018 ◽

Vol 31 (04) ◽

pp. 291-297

Author(s):

Taylan Önyay ◽

Kamil İnal ◽

Deniz Özbakır ◽

Ahmet Özak ◽

Cenk Yardımcı

Keyword(s):

Retrospective Study ◽

Clinical Outcomes ◽

Injured Limb ◽

Clinical Utilization ◽

Removal Time ◽

Hybrid External Fixator ◽

Early Use ◽

Clinical Benefits ◽

Age And Sex

Objective This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Study Design Retrospective study. Animals Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Method Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Results Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. Conclusion A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

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Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211056678 ◽

2021 ◽

Vol 9 (12) ◽

pp. 232596712110566

Author(s):

Soroush Baghdadi ◽

David P. VanEenenaam ◽

Brendan A. Williams ◽

J. Todd R. Lawrence ◽

Kathleen J. Maguire ◽

...

Keyword(s):

Children And Adolescents ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Demographic Data ◽

Quadriceps Tendon ◽

Graft Size ◽

Operative Notes ◽

Tendon Autograft ◽

Graft Diameter ◽

Mri Measurements

Background: There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose: To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results: A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age ( P = .04) and quadriceps thickness on MRI ( P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion: Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

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Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519885371 ◽

2019 ◽

Vol 48 (1) ◽

pp. 93-98 ◽

Cited By ~ 4

Author(s):

Alexia G. Gagliardi ◽

Patrick M. Carry ◽

Harin B. Parikh ◽

Jay C. Albright

Keyword(s):

Acl Reconstruction ◽

Graft Failure ◽

Cruciate Ligament ◽

Return To Sport ◽

Quadriceps Tendon ◽

Acl Injuries ◽

Patient Reported ◽

Adolescent Patients ◽

Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

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Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports after Hamstring Autograft Reconstruction for Sternoclavicular Joint Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00339 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0033

Author(s):

Lucca Lacheta ◽

Brandon Goldenberg ◽

Marilee Horan ◽

Sam Rosenberg ◽

Jonas Pogorzelski ◽

...

Keyword(s):

Patient Satisfaction ◽

Clinical Outcomes ◽

Joint Instability ◽

Hamstring Tendon ◽

Rate Of Return ◽

Return To Sports ◽

Joint Reconstruction ◽

Hamstring Tendon Autograft ◽

Tendon Autograft

Objectives: Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathology, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC reconstruction using a hamstring tendon autograft is a commonly used treatment option, but mid-term results are still lacking. To assess clinical outcomes, survivorship, and return to sports rate after SC joint reconstruction using hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, a high survivorship, and a high rate of return to sports. Methods: All patients who underwent SC joint reconstruction with a hamstring tendon autograft for SC joint instability, with a minimum 5-year follow up, were included. Patient reported outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) Score, Single Assessment Numerical Evaluation (SANE) Score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) Score, General heath physical component of the SF-12 (PCS) and patient satisfaction. Survivorship of reconstruction was defined as no further SC joint dislocation events or revision surgery. Return to sports and pain were assessed using a customized questionnaire. Results: 22 SC joint reconstructions with a mean age of 31.3 (range 15.8 - 57.0 years) at the time of surgery were included. At final evaluation, 18 SC joint reconstructions with a mean follow up of 6.0 years (range 5.0 – 7.3 years) were eligible for minimum 5-year follow-up. All clinical outcome scores improved significantly pre- to postoperatively, ASES (50.0 to 91.0; p = .005), SANE (45.9 to 86.0; p = .007), QuickDASH (44.2 to 12.1; p = .003), and PCS (39.4 to 50.9; p = .001). Median postoperative satisfaction was 9 (range 7 - 10). The construct survivorship was 90% at 5-year follow-up. Two patients failed at 82 and 336 days postoperatively and were revised with revision SC joint reconstruction and capsulorrhaphy. Another patient had a superficial wound infection, which was debrided once, and resulted in a good clinical outcome. Of the patients who answered optional sports activity questionnaires, 17 (77%) shoulders participated in recreational or professional sports before injury. At final follow-up, 16/17 (94%) shoulders returned to their pre-injury level of sport or better. The VAS score for pain today (p = 0.004) and pain at its worst (p = 0.004) improved significantly pre- to postoperatively. Conclusions: SC joint reconstruction with hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at mid-term follow up. Furthermore, a reliable rate of return to previous level of sports was observed in this young and high-demanding patient population. Concerns in terms of advanced post-instability arthritis were not confirmed since a significant decrease in pain was found after minimum 5-year follow-up.

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Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119887673 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711988767

Author(s):

Lu Bai ◽

Siyao Guan ◽

Tian You ◽

Wentao Zhang ◽

Peng Chen

Keyword(s):

Retrospective Study ◽

Achilles Tendon ◽

Clinical Outcomes ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Hamstring Graft ◽

Early Recovery ◽

Level Of Evidence ◽

Type 3

Background: Chronic Achilles tendon rupture is challenging to repair, and many procedures have been suggested to fill the gap that separates the distal and proximal ends of the ruptured tendon. Purpose: To compare clinical outcomes between the free hamstring graft (HG) and gastrocnemius turn flap (GTF) procedures in the treatment of chronic Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 26 patients (25 males, 1 female; mean age, 36.7 years; range, 22-53 years) with Kuwada type 3 chronic rupture of the Achilles tendon. A total of 11 patients underwent GTF surgery, whereas 15 patients underwent HG surgery. Follow-up assessments were conducted at 3, 6, and 12 months postoperatively. Results: The complication rate was significantly higher in the GTF group compared with the HG group (27.2% vs 6.6%, respectively; χ2 = 12.462; P = .001). At the 3-month follow-up, the degree of ankle dorsiflexion was significantly higher in the HG group than in the GTF group ( t = 3.144; P = .004). At 6-month and 1-year follow-up, no significant differences in ankle function were seen between the 2 groups. Conclusion: Hamstring tendon graft is associated with better early recovery of dorsiflexion compared with GTF. The long-term clinical outcomes of these 2 procedures are similar.

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Heterotopic ossification following total elbow arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-0535.r2 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 767-771 ◽

Cited By ~ 5

Author(s):

P. M. Robinson ◽

S. J. MacInnes ◽

D. Stanley ◽

A. A. Ali

Keyword(s):

Retrospective Study ◽

Heterotopic Ossification ◽

Clinical Outcomes ◽

Total Elbow Arthroplasty ◽

Range Of Movement ◽

Exact Test ◽

Elbow Arthroplasty ◽

Fisher’S Exact Test ◽

Trauma Group

Aim The primary aim of this retrospective study was to identify the incidence of heterotopic ossification (HO) following elective and trauma elbow arthroplasty. The secondary aim was to determine clinical outcomes with respect to the formation of heterotopic ossification. Patients and Methods A total of 55 total elbow arthroplasties (TEAs) (52 patients) performed between June 2007 and December 2015 were eligible for inclusion in the study (29 TEAs for primary elective arthroplasty and 26 TEAs for trauma). At review, 15 patients (17 total elbow arthroplasties) had died from unrelated causes. There were 14 men and 38 women with a mean age of 70 years (42 to 90). The median clinical follow-up was 3.6 years (1.2 to 6) and the median radiological follow-up was 3.1 years (0.5 to 7.5). Results The overall incidence of HO was 84% (46/55). This was higher in the trauma group (96%, 25/26) compared with the elective arthroplasty group (72%, 21/29) (p = 0.027, Fisher’s exact test). Patients in the trauma group had HO of higher Brooker class. The presence of HO did not significantly affect elbow range of movement within the trauma or elective groups (elective arthroplasty, Mann–Whitney U test, p = 0.070; trauma arthroplasty, p = 0.370, Mann–Whitney U test). Conclusion HO after total elbow arthroplasty is seen more commonly than previously reported. We have reported a significantly higher rate of HO in TEAs performed for trauma than those performed electively. Cite this article: Bone Joint J 2018;100-B:767–71.

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