Abstract
Purpose
The purpose of this study is to develop a comprehensive complications profile for quadriceps tendon-autograft anterior cruciate ligament reconstruction (QT ACL-R).
Methods
A traditional and grey literature search was conducted in accordance with PRISMA and R-AMSTAR guidelines. PubMed, EMBASE, MEDLINE, CINAHL, Cochrane, Web of Science, and many grey literature sources were searched from inception to May 29, 2022. All studies were searched and screened in duplicate with included studies being of all levels of evidence, reporting complications, and with patients of all ages undergoing primary ACL reconstruction with quadriceps tendon autograft in the last 15 years. Studies were excluded if they had cadaveric or animal subjects or were reviews. Risk of bias assessment was conducted using MINORS criteria for non-randomised studies and Cochrane’s RoB 2.0 for randomised studies. Data were summarised with weighted event rates generated under a random-effects model.
Results
A total of 55 studies (5315 reconstructions) were included: 32 used quadriceps tendon with bone block (B-QT), 19 used all-soft tissue quadriceps tendon (S-QT), and four did not report the QT graft subtype used. Included patients had an age range of 6.2–58 years and an average reported follow-up time of 28.1 months (range, 6–90 months) for non-randomised studies and 34.3 months (range, 0.233–120 months) for randomised studies. Pooled incidence rates for clinically relevant major complications included contralateral ACL injury at 6.0%, postoperative meniscal issues at 5.4%, cyclops lesions at 4.8%, graft failure at 4.1%, patellar fracture at 2.2%, hardware removal at 1.7%, infection at 1.5%, and donor-site quadriceps tendon rupture at 0.7%. Pooled incidence rates for clinically relevant minor complications included anterior knee pain at 9.7%, kneeling pain at 9.5%, sensation deficits at 4.4%, loss of extension at 4.2%, donor-site tendinopathy at 3.9%, cosmetic issues at 1.8%, and hematoma at 1.5%.
Conclusions
QT ACL-R resembles other graft types in its rates and types of postoperative complications. In this exploratory systematic review, no complications of QT ACL-R were found to be disproportionately represented in the literature. This graft type should remain an option with comparable complication rates to other graft choices.
Level of evidence
Level IV.
Registration
This study was preregistered under PROSPERO with preregistration code CRD42022302078.
Similar content being viewed by others
Change history
30 November 2022
A Correction to this paper has been published: https://doi.org/10.1007/s00167-022-07217-7
Abbreviations
- ACL:
-
Anterior cruciate ligament
- ACL-R:
-
Anterior cruciate ligament reconstruction
- B-QT:
-
Bone–quadriceps tendon
- BPTB:
-
Bone–patellar tendon–bone
- CD:
-
Clavien–Dindo
- HT:
-
Hamstrings tendon
- IKDC:
-
International Knee Documentation Committee
- KOOS:
-
Knee Injury and Osteoarthritis Outcome Score
- MINORS:
-
Methodological Index for Non-Randomised Studies
- NR:
-
Not reported
- PCL:
-
Posterior cruciate ligament
- PRISMA:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PROMs:
-
Patient-reported outcome measures
- QT:
-
Quadriceps tendon
- R-AMSTAR:
-
Revised Assessment of Multiple Systematic Reviews
- S-QT:
-
All-soft tissue quadriceps tendon
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Supplementary figure 4 Pooled incidence analysis for contralateral ACL injury. Note that figures 4–18 are available as online supplements. Supplementary figure 5 Pooled incidence analysis for postoperative meniscal issues. Supplementary figure 6 Pooled incidence analysis for cyclops lesion. Supplementary figure 7 Pooled incidence analysis for graft failure. Supplementary figure 8 Pooled incidence analysis for patellar fracture. Supplementary figure 9 Pooled incidence analysis for hardware removal. Supplementary figure 10 Pooled incidence analysis for infection. Supplementary figure 11 Pooled incidence analysis for donorsite quadriceps tendon rupture. Supplementary figure 12 Pooled incidence analysis for anterior knee pain. Supplementary figure 13 Pooled incidence analysis for kneeling pain. Supplementary figure 14 Pooled incidence analysis for sensation deficits. Supplementary figure 15 Pooled incidence analysis for loss of extension. Supplementary figure 16 Pooled incidence analysis for donor-site tendinopathy. Supplementary figure 17 Pooled incidence analysis for cosmetic issue. Supplementary figure 18 Pooled incidence analysis for hematoma (DOCX 902 kb)
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Singh, H., Glassman, I., Sheean, A. et al. Less than 1% risk of donor-site quadriceps tendon rupture post-ACL reconstruction with quadriceps tendon autograft: a systematic review. Knee Surg Sports Traumatol Arthrosc 31, 572–585 (2023). https://doi.org/10.1007/s00167-022-07175-0
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DOI: https://doi.org/10.1007/s00167-022-07175-0