Hamstring vs. All-Soft-Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Early Follow-Up Results of a Prospective Study

Abstract

Background: The quadriceps tendon (QT) autograft has recently drawn attention for anterior cruciate ligament reconstruction (ACLR). Finding the best autograft option for adolescents after an ACL injury is essential to ensure them a high-quality active lifestyle. There are no studies comparing the all-soft-tissue QT autograft with the hamstring tendon (HT) autograft in such population. Methods: In this study, 68 patients younger than 18 years of age were assigned to the HT (38 patients) or the QT (30 patients) ACLR group. The groups were similar, allowing their comparison. The instrumented knee laxity was evaluated with a Genourob arthrometer. In total, 48 patients (27 HT and 21 QT) were tested 3 months post-op, and 45 patients (26 HT and 19 QT) were tested 6 months post-op. Results: We found that 3 months post-op, the side-to-side anterior tibial translation measurements (GNRB1) were worse in the HT than in the QT group (1.4 (0.2–5.2; 1.715) vs. 0.6 (0.1–2.1; 0.905) mm, p = 0.02). There was no difference in side-to-side anterior tibial translation at 6 months post-op (GNRB2) between the HT and the QT group (1 (0.2–5.3; 1.519) vs. 1.1 (0.3–3.4; 1.279) mm, p = 0.927). At 3 months post-op, the side-to-side anterior tibial translation (GNRB1) was worse in males than in females. irrespective of the graft choice (1.45 (0.1–5.2; 1.696) vs. 0.4 (0.1–3.4; 0.89) mm, p = 0.016). The displacement curve slopes 6 months post-op were better for females (3 (0–13.1; 3.335) vs. 5.3 (0–26.1; 7.848), p = 0.014). At 3 months post-op, the GNRB measurements showed that the side-to-side anterior tibial translation (GNRB1) was better for females when the HT autograft had been used (0.45 (0.2–3.4; 0.942) vs. 2.4 (0.3–5.2; 2.333) mm, p = 0.003). In general, both autografts provided excellent objective outcomes at early follow-up. Conclusions: The all-soft-tissue QT autograft should be considered as a reliable alternative for ACLR in adolescents. This autograft has at least the same properties as the HT autograft in the early stages after ACL reconstruction in adolescent athletes and, in some respects, seems superior to the HT autograft. Research should continue to find the best possible graft choice for the most active and willing-to-return-to-sport population.