Varying Definitions of Return to Sport, Study Quality, and Outcome Measurements Limit Comparison of Primary ACL Reconstruction with Quadriceps Tendon Autografts to Hamstring and Bone-Patellar Tendon-Bone Autografts: A Systematic Review.

Abstract

Purpose: To systematically review the existing literature on RTS outcomes for QT autografts compared to HT and/or BPTB autografts for primary ACLR.

Methods: PubMed/Medline, Scopus, Embase, and Cochrane Library databases were queried for studies comparing RTS data for ACLR with QT autografts versus HT and/or BPTB autografts in accordance with PRISMA guidelines. Inclusion criteria were randomized and non-randomized prospective or retrospective studies evaluating primary ACLR containing RTS data for QT autograft and at least one other graft type. Exclusion criteria included patients <18 years of age, patients undergoing revision ACLR, cadaveric/animal studies, and studies lacking graft outcome data. Included studies were analyzed for methodological data, RTS data, quality, and risk of bias.

Results: Ten articles (two RCTs, three prospective studies, and five retrospective studies) comprising 1006 reconstructions with a level of evidence of II-III and average follow-up of 8-120 months were included. Non-randomized studies most frequently possessed a MINORS quality rating of "moderate," while half of the randomized studies had a Risk of Bias 2.0 rating of "some concern of bias." Four subjective definitions of RTS were identified: (1) return to pre-injury activity level based on the Tegner activity scale; (2) return to play; (3) return to level I/II (cutting) sports; and (4) return to pre-injury sports. RTS and mean time to RTS rates ranged from 16-100% and 8.4-11.1 months for QT autografts, 32-100% and 8.8 months for HT autografts, and 64-85% and 8.1 months for BPTB autografts.

Conclusions: Primary ACLR with QT autografts demonstrates similar overall RTS rates and mean time to RTS as HT and BPTB autografts. However, insufficient quality and quantity of studies investigating RTS outcomes for QT autografts underscores the unreliability of the current literature and need for high-quality, prospective studies.

Level of evidence: Level III, systematic review of Level II and III studies.