Anterior Cruciate Ligament Reconstruction: Autogenous Quadriceps Tendon-bone Compared with Bone-patellar Tendon-bone Grafts at 2-year Follow-up

Purpose: The purpose of this study was to evaluate and compare postoperative anterior knee pain, knee stability, and functional scores of an autogenous bone-patellar tendon-bone (BPTB) graft and a quadriceps tendon-bone (QTB) graft.

Methods: A total of 48 patients--27 who had anterior cruciate ligament (ACL) reconstruction by use of an autogenous BPTB graft and 21 who had ACL reconstruction by use of a QTB graft--were assessed at a minimum follow-up of 24 months after surgery. An accelerated rehabilitation program was adapted, and the rehabilitation protocol was identical for both groups.

Results: The mean side-to-side difference as measured with a KT-2000 arthrometer (MEDmetric, San Diego, CA) was 2.73 mm (SD, 1.45 mm) in the BPTB group and 2.79 mm (SD, 1.32 mm) in the QTB group (P = .880). Postoperatively, the International Knee Documentation Committee score was grade A or B in 23 patients (85.2%) in the BPTB group and 18 (85.7%) in the QTB group (P = .997). The mean anterior knee pain score was 86.9 in the BPTB group as compared with 90.2 in the QTB group (P = .107). In a kneeling posture, 13 BPTB patients reported discomfort (moderate in 10 and severe in 3) whereas only 4 QTB patients had moderate discomfort (P = .029). No significant differences were found with regard to other activities surveyed.

Conclusions: A QTB graft attached with the EndoPearl device (Linvatec, Largo, FL) appears to be an effective alternative for single-bundle ACL reconstruction. When followed with an accelerated rehabilitation program, reconstruction with a QTB graft provided knee stability comparable to a BPTB graft but with less kneeling pain than a BPTB graft.