CLINICAL TRIALS |
Buescu et al.,1717. Häner M, Bierke S, Petersen W. Anterior cruciate ligament revision surgery: ipsilateral quadriceps versus contralateral semitendinosus-gracilis autografts. Arthroscopy. 2016;32(11):2308-17. 2017 |
Parallel randomized clinical trial |
N = 48 |
Anatomical arthroscopic reconstruction of the ACL in single-bundle |
(1) QT (n = 24 patients). |
Pain: VAS - patients who required complementary analgesia (n/%) |
None |
Yes |
(1) QT 0-1 2h: 12 (50%) |
Male: 45 |
QT 25-48 h: 4 (16.66%) |
Romania |
Average follow-up: 0-48 h |
Female: 3 |
(1) HT (n = 24 patients). |
(2) HT 0-1 2h: 18 (75%) |
Age: 28.35 ± 7.19 |
HT 25-48 h: 9 (37.50%) |
(p = 0.002). |
Horstmann et al.,1818. Horstmann H, Petri M, Tegtbur U, Felmet G, Krettek C, Jagodzinski M. Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial. Arch Orthop Trauma Surg. 2022;142(2):281-9. 2022 |
Randomized, controled clinical trial |
N = 51 |
Press-fit fixation techniques without implant. |
(1) QT (n = 24 patients). |
Functional results by Lysholm: |
Yes |
Yes |
(1) QT Preoperative: 72.3 ± 13.2 |
Sex: |
QT two years postoperatively: |
90.4 ± 11.9 |
Follow-up: 2 years |
Male/Female |
(2) HT Preoperative: 60.4 ± 18.5 |
(1) QT: 21/3 |
HT two years postoperatively: |
Germany |
(2) HT: 12/15 |
(1) HT (n = 27 patients). |
83.5 ± 17.4 |
Age: |
p < 0.131 |
Evaluation: 3, 6, 12, and 24 months after surgery. |
(1) QT:24.1 ± 3.6 |
Return to sport (in days): |
(1) QT: 82.1 ± 45.6 |
(2) HT:32.7 ± 11.4 |
(2) HT: 95.2 ± 45.5 |
p < 0.131 |
Sinding et al.,2323. Sinding KS, Nielsen TG, Hvid LG, Lind M, Dalgas U. Effects of autograft types on muscle strength and functional capacity in patients having anterior cruciate ligament reconstruction: a randomized controlled trial. Sports Med. 2020;50(7):1393-403. 2020 |
Randomized, controled clinical trial |
N = 85 |
ACL Reconstruction |
(1) QT (n = 42 patients). |
Function: When comparing the two groups of patients with autograft, 4%-11% less muscle strength was observed during knee extensor at 0 degrees/s (isometric, MVIC) and 60 degrees/s (concentric dynamics) in QT vs. HT, along with knee extensor 4% lower RFD200ms. |
NR |
Yes |
Sex: |
Male/Female |
(1) QT: 25/17 |
Denmark |
Follow-up: 1 year |
(2) HT: 23/20 |
(1) HT (n = 43 patients). |
Functional Capacity (single leg hop distance - SHD): There was no difference in SHD between HT and QT. |
Age: |
(1) QT:28.7 ± 6.4 |
(2) HT: 28.3 ± 6.2 |
Vilchez-Cavazos et al.,2626. Vilchez-Cavazos F, Dávila-Martínez A, Garza-Castro S, Simental-Mendía M, Garay-Mendoza D, Tamez-Mata Y, et al. Anterior cruciate ligament injuries treated with quadriceps tendon autograft versus hamstring autograft: a randomized controlled trial. Cir Cir. 2020;88(1):76-81. 2020 |
Randomized clinical trial |
N = 28 |
ACL Reconstruction |
(1) QT (n = 14 patients). |
Functional results by Lysholm (median and interquartile range): |
NR |
Yes |
(1) QT baseline: 75.0 (61.5-83.5) |
Sex: |
QT 12 months: 95.0 (91.0-100.0) |
Male/Female |
(2) HT baseline: 61.0 (37.0-74.0) |
Follow-up: |
(1) QT: 11/2 |
HT 12 months: 98.0 (90.0-100.0) |
Mexico |
2 weeks and 1, 3, 6 and 12 months. |
(2) HT: 12/3 |
(1) HT (n = 14 patients). |
Pain (VAS) (median and interquartile range): |
Age: |
(1) QT baseline: 3.0 (1.5-7.0) |
(1) QT: 30.64 ± 8.71 |
QT 12 months: 0.0 (0.0-1.5) |
(2) HT: 28.60 ± 6.74 |
(2) HT baseline: 4.0 (3.0-7.0) |
HT 12 months: 0.0 (0.0-1.0) |
OBSERVATIONAL STUDIES |
Akoto et al.,88. Akoto R, Albers M, Balke M, Bouillon B, Höher J. ACL reconstruction with quadriceps tendon graft and press-fit fixation versus quadruple hamstring graft and interference screw fixation - a matched pair analysis after one year follow up. BMC Musculoskelet Disord. 2019;20(1):109. 2019 |
Retrospective cohort study |
N = 82 |
Isolated ACL reconstruction |
(1) QT (n = 41 patients). |
Functional results by IKDC scores: |
Graft failure: |
Yes |
(1) QT: 86.4 ± 14.2 |
(1) QT: n = 3 |
Male: 64 |
(2) HT: 86.7 ± 10.9 |
(2) HT: n = 4 |
Female: 18 |
p = 0.9 |
Contralateral ACL rupture: |
Germany |
Follow-up: 12 months |
Age: |
(1) HT (n = 41 patients). |
Functional tests |
(1) QT: n = 1 |
(1) QT: 29 ± 10 |
(One-Leg Hop test): |
(2) HT: n = 2 |
(1) QT: 96.2 ± 8.5 |
Infection: |
(2) HT: 28 ± 10 |
(2) HT: 95.5 ± 8.5 |
(1) QT: n = 1 |
p = 0.8 |
(2) HT: n = 2 |
Cavaignac et al.,1616. Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J. Is quadriceps tendon autograft a better choice than hamstring autograft for anterior cruciate ligament reconstruction? A comparative study with a mean follow-up of 3.6 years. Am J Sports Med. 2017;45(6):1326-32. 2017 |
Cohort study |
N = 86 |
Isolated ACL reconstruction |
(1) QT (n = 45 patients). |
Functional results by Lysholm: |
QT group, there was 1 re-rupture |
Yes |
(1) QT: 89 ± 6.9 |
Male: 45 |
(2) HT: 83.1 ± 5.3 |
Female: 41 |
p < 0.05 |
Switzerland |
Average follow-up: 3.6 6 0.4 years, and the minimum follow-up was 3 years |
Age: |
(1) HT (n = 41 patients). |
Pain: |
In the HT group, there were 2 cases of graft rupture. |
(1) QT: 32.1 ± 8 |
(1) QT: 90 ± 6.8 |
(2) HT: 30.9 ± 9 |
(2) HT: 86 ± 7.2 |
p = 0.23 |
Häner et al.,1717. Häner M, Bierke S, Petersen W. Anterior cruciate ligament revision surgery: ipsilateral quadriceps versus contralateral semitendinosus-gracilis autografts. Arthroscopy. 2016;32(11):2308-17. 2016 |
Cohort study |
N = 51 |
ACL Reconstruction homologous autograft (HT and QT) |
(1) QT (n = 25 patients). |
Functional results by Lysholm: |
No rerupture occurred during postoperative follow-up. No early superficial or meniscal infection. |
Yes |
(1) QT: 88 |
Sex: |
(2) HT: 78.1 |
p = 0.06 |
Male/Female |
|
Pain: |
(1) QT: 17/8 |
When kneeling |
(1) QT: 7 |
Germany |
Average follow-up: 24 months |
(2) HT: 18/8 |
(1) HT (n = 26 patients). |
(2) HT: 11 |
Lesion was found in either group. |
When squatting |
Age: |
(1) QT: 7 |
Climb stairs |
(1) QT: 35.9 ± 10.4 |
(1) QT:4 |
(2) HT: 4 |
(2) HT: 35.8 ± 13.1 |
In squats |
(2) HT:8 |
Johnston et al.,1919. Johnston PT, Feller JA, McClelland JA, Webster KE. Strength deficits and flexion range of motion following primary anterior cruciate ligament reconstruction differ between quadriceps and hamstring autografts. J ISAKOS. 2021;6(2):88-93. 2021 |
Cohort study |
N = 111 |
Arthroscopy-assisted ACL reconstruction with femoral tunnel perforated via anteromedial portal |
(1) QT (n = 37 patients). |
Previous knee pain: |
NR |
Yes |
Sex: |
(1) QT: 67% |
Male/Female |
(2) HT: 63% |
(1) QT: 29/8 |
p = N.S. |
Australia |
Follow-up: 6 months |
(2) HT: 58/16 |
(1) HT (n = 74 patients). |
Active knee flexion amplitude while standing (p < 0.001), active knee flexion amplitude measured in lateral decubitus (p < 0.001), and passive knee flexion amplitude (p = 0.016) in the HT Group when compared with the QT group. |
Age: |
(1) QT: 20.0 (15-34) |
(2) HT: 20.5 (15-32) |
Lee et al.,2020. Lee JK, Lee S, Lee MC. Outcomes of anatomic anterior cruciate ligament reconstruction: bone-quadriceps tendon graft versus double-bundle hamstring tendon graft. Am J Sports Med. 2016;44(9):2323-9. 2016 |
Cohort study |
N = 96 |
ACL Reconstruction |
(1) QT (n = 48 patients). |
Lysholm scores: |
NR |
Yes |
Sex: |
(1) QT Preoperative: 70.2 ± 9.6 |
Male/Female |
QT final follow-up: 92.1 ± 8.7 |
(1) QT: 44/4 |
(2) HT Preoperative: 69.4 ± 18.0 |
Korea |
Follow-up: 2 years |
(2) HT: 44/4 |
(1) HT (n = 48 patients). |
HT final follow-up: 88.4 ± 11.9 |
Age: |
p = 0.30 |
(1) QT: 31.1 (17-57) |
The recovery of flexor muscle strength was better in the quadriceps group (86.6% vs. 92.2% at 60 degrees/s, p = 0.22; 87.1% vs. 99.6% at 180 degrees/s, p = 0.01). |
(2) HT: 29.9 (17-58) |
Ortmaier et al.,2121. Ortmaier R, Fink C, Schobersberger W, Kindermann H, Leister I, Runer A, et al. Return to sports after anterior cruciate ligament injury: a matched-pair analysis of repair with internal brace and reconstruction using hamstring or quadriceps tendons. Sportverletz Sportschaden. 2021;35(1):36-44. 2021 |
Retrospective cohort study |
N = 45 patients |
ACL Reconstruction homologous autograft (HT and QT) |
(1) QT (n = 20 patients). |
Knee pain (VAS): Subjective assessments of pain during and after sports worsened significantly for almost all parameters with no significant difference between pre- and postoperative groups. |
NR |
Yes |
Sex: |
Male/Female |
Austria |
Follow-up: 12 months |
(1) QT: 17/8 |
(1) HT (n = 25 patients). |
(2) HT: 12/8 |
Rate of return to sports was 91.3%. |
Age (average): 33.4 years |
Runer et al.,2222. Runer A, Wierer G, Herbst E, Hepperger C, Herbort M, Gföller P, et al. There is no difference between quadriceps- and hamstring tendon autografts in primary anterior cruciate ligament reconstruction: a 2-year patient-reported outcome study. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):605-14. 2018 |
Prospective cohort study |
N = 80 patients |
ACL Reconstruction homologous autograft (HT and QT) |
(1) QT (n = 40 patients). |
Lysholm scores: |
During the QT graft collection process, no joint capsule opening or patellar fracture was observed. Postoperatively, no major quadriceps bleeding or hematoma was reported or observed. |
Yes |
(1) QT Preoperative: 94.7 ± 8.2 |
Sex: |
QT final follow-up: 93.4 ± 7.5 |
Male/Female |
(2) HT Preoperative: 94.1 ± 9.9 |
(1) QT: 23/17 |
HT final follow-up: 93.4 ± 8.7 |
None of the QT patients reported tenderness, numbness, or irritation at the graft collection site. |
Austria |
Follow-up: 6, 12, and 24 months after surgery. |
(2) HT: 23/17 |
(1) HT (n = 40 patients). |
Pain (VAS): |
Age (average): |
(1) QT Preoperative: 0.90 ± 1.1 |
Rerupture: Over the 2 years of follow-up, one graft rupture occurred in the HT group, while no further ruptures were recorded in the QT group (n.s.). The re-rupture occurred as a result of the player's contact during a football game. |
(1) QT: 34.6 ± 11.0 |
QT final follow-up: 0.6 ± 1.0 |
(2) HT: 34.4 (± 11.0) |
(2) HT Preoperative: 0.8 ± 1.0 |
HT final follow-up: 0.8 ± 1.2 |
Sofu et al.,2424. Sofu H, Sahin V, Gürsu S, Yildirim T, Issin A, Ordueri M. Use of quadriceps tendon versus hamstring tendon autograft for arthroscopic anterior cruciate ligament reconstruction: a comparative analysis of clinical results. Eklem Hastalik Cerrahisi. 2013;24(3):139-43. 2013 |
Retrospective cohort study |
N = 44 patients |
ACL Reconstruction homologous autograft (HT and QT) |
(1) QT (n = 23 patients). |
Lysholm scores < 64 (poor): |
NR |
Yes |
Sex: |
Male/Female |
(1) QT Preoperative: 22 (95.6%) |
(1) QT: 21/02 |
QT final follow-up: 1 (4.3%) |
Turkey |
Follow-up: 37.6 months |
(2) HT: 21/0 |
(1) HT (n = 21 patients). |
(2) HT Preoperative: 19 (90.5%) |
Age (average): |
|
(1) QT: 26.8 |
HT final follow-up: 0 (0%) |
(2) HT: 28.6 |
Todor et al.,2525. Todor A, Nistor DV, Caterev S. Clinical outcomes after ACL reconstruction with free quadriceps tendon autograft versus hamstring tendons autograft. A retrospective study with a minimal follow-up two years. Acta Orthop Traumatol Turc. 2019;53(3):180-3. 2019 |
Retrospective cohort study |
N = 72 patients |
ACL Reconstruction homologous autograft (HT and QT) |
(1) QT (n = 39 patients). |
Lysholm scores: |
In both groups, there were no readmissions or reoperations due to complications. There was one patient in the QT group with a lateral difference of 5 mm in the KT-1000 test and was considered a failure. No patient in the HT group had a difference of more than 3 mm. |
Yes |
Sex: |
Male/Female |
(1) QT Post-operative: 89.20 ± 9.97 |
(1) QT: 26/13 |
Romania |
Follow-up: 24 months |
(2) HT: 23/10 |
(1) HT (n = 33 patients). |
(1) HT Post-operative: 91.33 ± 6.65 |
5 patients in the QT group (12.82%) reported an unsatisfactory aesthetic appearance of the suprapatellar incision and 8 patients in the HT group (24.24%) reported mild numbness in the anteromedial face of the leg. |
Age (average): |
(1) QT: 30.64 ± 8.71 |
p = 0.299 |
(2) HT: 28.60 ± 6.74 |