the quadriceps tendon: the forgotten graft?
DESCRIPTION
The Quadriceps Tendon: The Forgotten graft?. Systematic Review of Primary ACL Reconstruction utilising Autograft Quadriceps Tendon S Hutchinson, J Mulford. Quadriceps tendon had increased interest in recent times as a graft for primary ACL surgery. - PowerPoint PPT PresentationTRANSCRIPT
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The Quadriceps Tendon: The Forgotten graft?
Systematic Review of
Primary ACL Reconstruction utilising
Autograft Quadriceps Tendon
S Hutchinson, J Mulford
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• Quadriceps tendon had increased interest in recent times as a graft for primary ACL surgery.
• We wanted to know the outcomes utilising this graft when compared to traditional autografts
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Technique
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Aim
• Clarify the outcomes with use of the quadriceps tendon in primary ACL surgery.
• Systematic review process was utilised.
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Proposed Benefits of Quads Graft
• Thicker tendon cf patella tendon• Ability to be consistently used as a
double bundle graft• Provides bone healing on one side• Less anterior knee pain cf patella
tendon• Less stretching cf hamstring tendon
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Method
• A search process utilising: MEDLINE (1966-2010), EMBASE (1980-2010), CINAHL, Google search engine.
• Review of references of all articles identified in the search.
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Inclusion and Exclusion Criteria• Inclusion criteria
– 1. Original articles with patients with primary ACL rupture treated with a quadriceps tendon autograft.
– 2. Articles which reported on one or more of the primary outcomes.
• Exclusion Criteria– 1. Articles which did not document minimum length of patient follow-
up.– 2. Studies with less than 12 months of patient follow-up.– 3. Duplicate publication of any type, for example abstracts,
comments, review or technique articles, duplicate reports and articles based on preliminary data from larger series.
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Pre Determined Outcomes• Subjective
– Anterior/patellofemoral/ kneeling pain – patient satisfaction.
• Objective – Range of motion (flexion loss or extension loss > 5 degrees)– Lachman Grade, pivot shift grade– IKDC score– KT-1000– return to pre-injury level, – muscle strength (flexion and extension strength), – Lysholm score– surgery complications (Specifically graft rupture or failure, patella
fracture and infection).
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• Data extracted independently by two reviewers
• Recorded – Methodology– predetermined outcome measures
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Results
• Initial search identified 45 article for review
• 16 articles met the inclusion criteria
• 4 articles compared graft types – 3 patella tendon vs QT; 1 hamstrings
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Comparison Articles• 3 compared PT to Quads• 1 compared Quads to HT
• Poor methodology and variability in reporting of outcomes
• No real difference except
• Anterior Knee Pain– 43 of 114 (38%) in patella tendon– 12 of 108 (11%) in quadriceps group
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All Articles
• All retrospective studies
• 1539 grafts
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Subjective Outcomes
• Patient satisfaction: 91% (303 of 332)
• Anterior knee pain: 3% (22 of 699)
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Objective Outcomes• Lachmann grade >1: 7% (52 of 684)
• Pivot Shift grade > 1: 8% (41 of 534)
• IKDC score A or B: 88% (592 of 676)
• Lysholm Score: Acceptable post op outcomes (89-94)
• Fixed flexion > 5 degrees 4% (27 of 730)
• Quads strength (<80%): 1 of 398
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Complications
• Graft failure: 3% (21 of 666)
• Patella fracture: 5
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Conclusion
• The quadriceps tendon is a viable alternative to traditional autografts.
• Anterior knee pain is less for quadriceps graft compared to patella tendon grafts.
• Thus our goal to set up a randomised trial
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Thankyou
Stephen Hutchinson Jonathan Mulford