All-inside ACL reconstruction improved functional outcomes
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Study results showed an all-inside full-thickness quadriceps tendon technique for ACL reconstruction yielded good to excellent functional results with low complication rates and comorbidities in young, high-demand athletes.
Daniel Slullitel, MD, and colleagues collected functional scales of Lysholm scores, IKDC scores, Tegner scores and objective results of side-to-side differences among 291 patients who underwent isolated primary ACL reconstruction using autologous full-thickness quadriceps tendon graft with bone block with an all-inside technique. Researchers analyzed complications and comorbidities.
Results showed Lysholm scores improved from 64 points preoperatively to 91 points at 5 years postoperatively. Although 22% of patents reported an ability to perform moderate activity and 78% of patients reported a sedentary life prior to surgery, researchers found 82% of patients reported being able to perform high-level physical activity and 10% of patients reported being able to perform mild activities at 5 years postoperatively. Researchers noted 59.79% and 3.4% of patients reported excellent and good IKDC scores, respectively. According to results of the arthrometric analysis, 89% of knees had a side-to-side difference of less than 3 mm. Results showed a median pre-injury Tegner score of 9 and a final median Tegner activity level of 8 at 5 years, with 73.3% of patients reporting return to their competitive pre-injury activity level.
At final follow-up, researchers found anterior knee pain in 5.15% of patients. Although two patients had a patellar fracture at the time of harvesting the graft that required fixation and led to a delay in immediate postoperative motion, researchers noted neither of these patients had decreased range of motion at 5-year follow-up.
Results showed 10.7% of patients experienced ACL re-rupture. Researchers reported no visualization difficulties or significant hematomas.
“Although this ‘all inside’ [full-thickness quadriceps tendon] FQT reports knee stability, complication rates and comorbidities similar to other types of reconstruction techniques, however our study is performed in a younger, more active sports involved population with a longer follow-up,” the authors wrote. “Nevertheless, we think that future prospective types comparing different quad reconstruction types are needed.”
- Reference:
- Galan H, et al. J Exp Orthop. 2020;doi:10.1186/s40634-020-00226-w.
- For more information:
- Daniel Slullitel, MD, can be reached at Ortopedia & Traumatologia Instituto Dr. Jaime Slullitel, San Louis 2534, S2000KPH Rosario, Santa Fe, Argentina; email: dahat123@gmail.com.
Perspective
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Bryson P. Lesniak, MD
Galan and colleagues published an interesting study on mid-term results of quadriceps tendon autograft ACL reconstruction. While a retrospective cohort series, it demonstrates results that many orthopedic surgeons have claimed about quadriceps tendon ACL reconstruction: it is effective, safe and comparable to other grafts. More recently, it has been shown that in young, active women, hamstring ACLs have increased failure rates. This might be explained by inadequate graft size as failure rates in hamstring ACLs correlate to graft diameter. There is no such issue with quadriceps tendon autograft. It can be sized as needed reliably and has been shown to have decreased anterior knee pain compared to patellar tendon. There is no ideal ACL graft, but it is clear quadriceps tendon should be in the orthopedist’s armamentarium.
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