Central Quadriceps Tendon for Anterior Cruciate Ligament Reconstruction: Long-term Results (SS-33)

Abstract

Anterior cruciate ligament reconstruction surgery with the central third quadriceps tendon yields a stable, high functioning knee with little associated morbidity at greater than two years of follow-up. The decreased donor site morbidity and absence of anterior knee pain suggest that the quadriceps free tendon autograft offers a reliable, pain-free, low morbidity autograft alternative in ACL reconstruction. Recent data suggest that this graft may be the least morbid of all currently used ACL autograft reconstruction alternatives. To describe the outcome of anterior cruciate ligament reconstruction (ACLR) using central quadriceps free tendon (CQFT) at a minimum of 2 years post-reconstruction. All patients more than two years from CQFT ACLR were invited to participate. Using the IKDC subjective form and an impartial examiner, range of motion, incisional/anterior knee pain, ligament excursion (KT-1000), and single-leg hop test were performed. The uninvolved knee was examined as a control. 124 patients completed the subjective (80) or both IKDC and objective testing (44). Eleven patients had bilateral reconstructions, four patients were revisions, and one patient had a concomitant meniscal repair. Seventy-one patients (42%) were lost to follow-up. There were five graft failures (4%) and one infection requiring re-operation. The average follow-up was 66 months (median 67, range 24 – 105) and the average IDKC score was 84.7 (89.7, 14.9 – 100). No patient had tenderness to palpation at the graft donor site, anterior knee pain, or extension lag. Knee range of motion was symmetric in all patients. The average difference in KT-1000 was 1.2 mm at twenty pounds (1.0, (-2) – 6) and 1.8 mm at manual maximum (1.2, 0.6 – 7.5). Thirty-eight patients (86%) had <3 mm side-to side difference. The single-leg hop test quotient was 0.96 (0.95, 0.65 – 1.35). CQFT is a reliable, low-morbidity autograft for ACL reconstruction with stable outcomes at an average of 5+ years. Most striking is the absence of extension lag, donor site morbidity and anterior knee pain.