No Clinically Significant Differences in Outcomes after Anterior Cruciate Ligament Reconstruction When Comparing Quadriceps, Bone Patellar Tendon Bone, and Hamstring Autografts of 9mm or Greater.

Purpose: The purpose of this study was to determine if there are patient-reported outcome differences in bone-patellar-tendon-bone (BTB), quadriceps tendon (QT), and hamstring (HS) grafts of comparable size.

Methods: We performed a retrospective analysis of global registry data to include all patients that had an ACL reconstruction with BTB, QT, or HS autograft of at least 9mm diameter between 2010 and 2021 with complete 1- and 2-year outcome scores. We compared 1- and 2-year postoperative outcome scores (VAS, KOOS pain, MARS, VR-12) between BTB, QT and HS of the same size graft.

Results: 2318 subjects were included in the analysis and all graft types showed improved PROMs at 1- and 2-years postoperatively when compared to baseline. The KOOS pain score for the BTB group was significantly better than the HS (between-group difference = 2.71, p<0.01) and QT (between-group difference = 2.51, p<0.01) groups at 1-year, and the BTB group was better than HS (between-group difference = 1.88, p<0.01) at 2-years. However, the differences were small and not clinically meaningful. When comparing graft type there were no differences in the percentage of patients who reached MCID, or clinical scores VAS, MARS at 2-years follow-up.

Conclusion: There is no clinically meaningful difference in KOOS-pain, VR-12, VAS, and MARS at 1- and 2-years postoperatively in patients having anterior cruciate ligament reconstruction with BTB, HS or QT if graft size is at least 9mm in diameter.

Level of evidence: III (Retrospective Comparative Study).