Description
Background: Anatomic rectangular tunnel anterior cruciate ligament reconstruction (ART-ACLR) can mimic the fiber arrangement of the native ACL and restore normal knee biomechanics, compared to the conventional round tunnel ACLR. ART-ACLR using a bone-patellar tendon-bone (BTB) graft can provide satisfactory clinical outcomes; however, some issues such as secondary ACL injury and donor site morbidity, including postoperative anterior knee pain (AKP), remain to be solved. Due to these issues, quadriceps tendon-bone (QTB) grafts have recently become more popular.
Purpose: This study aimed to compare the 2-year clinical outcomes of ART-ACLR with BTB and QTB autografts.
Methods: A total of 134 patients underwent primary ART-ACLR with BTB (N=70) or QTB (N=64). Each group was matched for age, sex, body mass index, and concomitant procedures. All patients had a minimum follow-up period of 2 years postoperatively. Outcome evaluations included the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), side-to-side differences (SSD) with the KT-1000 knee arthrometer, rate of secondary ACL injury, and incidence of AKP.
Results: All clinical scores significantly improved from preoperative to 6 months and further increased throughout the 2 year post-operative period in both groups. The IKDC and all subscales of the KOOS, except sports/recreation, were equivalent between the BTB and QTB groups at each time point. There were no significant differences in the SSD value of KT-1000 between the two groups. The rates of secondary ACL injury were 10.0% on the ipsilateral side and 2.9% on the contralateral side in the BTB group and 3.1% on the ipsilateral side and 4.7% on the contralateral side in the QTB group, with no significant difference between both groups. The incidence of AKP was 17.1% and 4.9% in the BTB and QTB group, respectively, with significance (P=0.0224).
Conclusion: The clinical scores, SSD value of KT-1000 and secondary ACL injury rates were equivalent between the BTB and QTB groups. However, the incidence of AKP was significantly lower in the QTB group, suggesting that QTB could be a favorable graft for ACLR.
