Torsten Grønbech Nielsen

Is quadriceps tendon a better graft choice than patellar tendon? a prospective randomized study

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

PURPOSE: The purpose of this randomized controlled study was to compare knee stability, kneeling pain, harvest site pain, sensitivity loss, and subjective clinical outcome after primary anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) or quadriceps tendon-bone (QTB) autografts in a noninferiority study design.

METHODS: From 2005 to 2009, a total of 51 patients were included in the present study. Inclusion criteria were isolated ACL injuries in adults. Twenty-five patients were randomized to BPTB grafts and 26 to QTB grafts. An independent examiner performed follow-up evaluations 1 and 2 years postoperatively. Anteroposterior knee laxity was measured with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Anterior knee pain was assessed clinically and by knee-walking ability. Knee Injury and Osteoarthritis Outcome Score (KOOS) and subjective International Knee Documentation Committee (IKDC) score were used for patient-evaluated outcome.

RESULTS: Anterior knee laxity was equal between the 2 groups with KT-1000 values of 1.1 ± 1.4 mm and 0.8 ± 1.7 mm standard deviation (SD) at follow-up in QTB and BPTB groups, respectively (P = .65), whereas positive pivot shift test results were seen less frequently (14% compared with 38%, respectively; P = .03). Anterior kneeling pain, evaluated by the knee walking ability test, was significantly less in the QTB group, with only 7% of patients grading knee walking as difficult or impossible compared with 34% in the BPTB group. At 1 and 2 years' follow-up, there was no difference between the 2 groups in subjective patient-evaluated outcome. The IKDC score was 75 ± 13 patients and 76 ± 16 SD at 1-year follow-up in QTB and BPTB groups, respectively (P = .78). At 2 years, 12 patients were lost to follow-up, resulting in 18 in the BPTB group and 21 in the QTB group.

CONCLUSIONS: The use of the QTB graft results in less kneeling pain, graft site pain, and sensitivity loss than seen with BPTB grafts; however, similar anterior knee stability and subjective outcomes are seen. The results of this study show that QTB is a viable option for ACL reconstruction.

LEVEL OF EVIDENCE: Level II, randomized controlled clinical trial.

Original languageEnglish
JournalArthroscopy: The Journal of Arthroscopy and Related Surgery
Pages (from-to)593-8
Number of pages6
Publication statusPublished - May 2014

Bibliographical note

Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

    Research areas

  • Adolescent, Adult, Anterior Cruciate Ligament/surgery, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction/adverse effects, Arthralgia/diagnosis, Female, Follow-Up Studies, Humans, Joint Instability/diagnosis, Knee Injuries/surgery, Knee Joint/physiopathology, Male, Middle Aged, Patellar Ligament/transplantation, Physical Therapist Assistants, Prospective Studies, Quadriceps Muscle/transplantation, Range of Motion, Articular, Treatment Outcome, Young Adult

See relations at Aarhus University Citationformats

ID: 222316977