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There are several factors that influence the patient-specific graft choice in primary anterior cruciate ligament reconstruction (ACLR) [15]. In Norway, hamstring tendons (HT) and bone patella-tendon bone (BPTB) autograft are the most commonly used grafts in ACLR [46]. BPTB autograft is reported to excel in restoring rotational laxity, promoting quicker graft-tunnel incorporation and facilitating a quicker return to high-level activity and are associated with lower revision rates [19, 32, 43, 45, 49]. Despite possible disadvantages such as anterior knee pain, risk of patella fracture [3, 26, 56, 59] and possibly an increased risk for osteoarthritis [64], some surgeons still consider the BPTB as the gold standard for ACLR [8].

The HT autografts may offer reduced donor site morbidity and improved initial extension strength of the knee compared with BPTB [37]. However, they come with potential disadvantages such as widening of the graft tunnels [29, 61], slower graft-tunnel healing [52], knee flexor strength reduction [12, 23], risk for increased knee laxity [11] and higher revision risk [19, 43, 65].

In recent years, the use of quadriceps tendon (QT) autograft has gained more popularity. A QT graft can be harvested with or without bone plug [39] (bone quadriceps-tendon; QTB), both demonstrating lower donor site morbidity compared with BPTB and HT [28, 41]. It has a predictable length and volume which might reduce the risk of failure [24, 42, 54, 55]. Furthermore, biomechanical, histological and magnetic resonance studies may favour QT graft compared with BPTB graft [9, 53, 57, 63]. However, previous published studies that evaluated BPTB, HT and QT (with or without bone plug) have reported similar outcomes with regard to function and suggested that ACLR with QT autograft is a reliable and safe choice [13, 18, 31, 47, 50, 54].

The Norwegian Knee Ligament Register (NKLR) was established in 2004, and all hospitals performing anterior cruciate ligament (ACL) surgery in Norway report to the register [21]. The results of QT ACL reconstructions in Norway have not been previously documented. This information could potentially assist both surgeons and patients in making well-informed decisions regarding graft selection. Based on the data from NKLR, we aimed to compare the revision rates and patient reported outcomes at 2 years after primary ACL reconstruction between QT, BPTB and HT autografts in Norway.

It was hypothesized that there would be no difference in the outcome at 2 years comparing patients who underwent ACLR with QT grafts with those who were operated with BPTB or HT grafts.

Los autoinjertos de hueso rotuliano-tendón (BPTB) y tendón de la corva (HT) son los injertos más utilizados en las reconstrucciones primarias del ligamento cruzado anterior (LCA) (LACR) en Noruega. El autoinjerto del tendón del cuádriceps (QT) ha ganado más popularidad en los últimos años. El propósito de este estudio es comparar las tasas de revisión y los resultados informados por los pacientes del QT primario con reconstrucciones del LCA con autoinjerto BPTB y HT en Noruega a los 2 años de seguimiento. Se planteó la hipótesis de que no habría diferencias en las tasas de revisión a los 2 años entre los tres autoinjertos.

Conclusión
El riesgo de revisión a 2 años después de ACLR con QT fue mayor que BPTB y similar a HT. No se encontraron diferencias entre los grupos en los resultados informados por los pacientes. Este estudio proporciona información valiosa tanto para los cirujanos como para los pacientes a la hora de tomar decisiones sobre la elección de autoinjertos en reconstrucciones primarias del LCA.

Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions – PubMed (nih.gov)

Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions – Zegzdryn – 2024 – Knee Surgery, Sports Traumatology, Arthroscopy – Wiley Online Library

Zegzdryn M, Moatshe G, Engebretsen L, Drogset JO, Lygre SHL, Visnes H, Persson A. Increased risk for early revision with quadriceps graft compared with patellar tendon graft in primary ACL reconstructions. Knee Surg Sports Traumatol Arthrosc. 2024 Mar;32(3):656-665. doi: 10.1002/ksa.12081. Epub 2024 Feb 20. PMID: 38375583.

© 2024 The Authors. Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.