A systematic review and meta-analysis of outcomes of quadriceps tendon autograft versus bone-patellar tendon-bone autografts for anterior cruciate ligament reconstruction

Abstract

Purpose: OBJECTIVE: To compare the effect of QT autograft and autograft on anterior cruciate ligament reconstruction. Methods: METHODS: A systematic search of the literature was performed in PubMed, EMbase, MEDLINE, Cochrane, Wanfang database and CNKI databases to identify published articles on clinical studies relevant to ACL reconstruction with comparing QT autograft versus autografts. Review Manager 5.3 statistical software was used to Meta analyze the literature data extracted from the eligible research Results in terms of difference between affected knee and healthy knee, Lachman test, pivot-shift test,Lysholm score, objective International Knee Documentation committee (IKDC) scores, anterior knee pain and graft failure. Results: Six clinical studies, including 1037 patients with ACL reconstruction met the inclusion criteria. Comparison of 548 QT versus 489 autografts showed no significant differences in terms of instrumented mean side-to-side difference (<3mm) [OR=1.53, 95%CI(0.68,3.44)P=0.31], (3-5mm) [OR=0.64, 95%CI(0.31,1.35)P=0.24], (>5mm) [OR=1.28, 95%CI(0.55,2.98)P=0.57],Lachman test grade 0 OR 1 [OR=0.88, 95%CI(0.38,2.02)P=0.76], pivot-shift test grade 0 OR 1 [OR=0.63, 95%CI(0.24,1.68)P=0.36], mean Lysholm score [OR=-0.14, 95%CI(-2.62,2.35)P=0.92], objective IKDC score [OR=0.87, 95%CI(0.47,1.60)P=0.66] OR graft failure [OR=0.76, 95%CI(0.28,2.02)P=0.58].However, QT autografts results showed less anterior knee pain (risk ratio between QT and group, OR=0.16, 95%CI(0.09,0.29)P<0.00001). Conclusions: Clinical and functional outcomes and graft survival rate for QT autograft were comparable with BPTB autografts. However, QT autograft had significantly less anterior knee pain compared with BPTB autograft,QT autograft is certainly a suitable alternative graft choice for patients undergoing ACL reconstruction.