A Randomized Controlled Trial Investigating Patient Recovery After Anterior Cruciate Ligament Reconstruction Undertaken With a Quadriceps Versus Hamstrings Tendon Autograft

This is the authors' abstract. We don't add key points for this paper.

INTRODUCTION & AIMS Anterior cruciate ligament (ACL) tears are common. However, a lack of high-quality evidence exists comparing different graft options in patients undergoing surgical reconstruction (ACLR). This randomized controlled trial (RCT) investigated the course of recovery in patients undergoing ACLR with either a quadriceps (QT) or hamstrings (HT) tendon autograft. METHODS This study randomized 112 patients to one of the two graft reconstruction cohorts (HT=55, QT=57), subsequently undergoing ACLR and a structured rehabilitation program. Patients were assessed pre-surgery and at 6 weeks and 3, 6, 12 and 24 months, with a range of patient-reported outcome measures (PROMs) including the International Knee Documentation Committee form (IKDC) and the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score. Graft laxity, peak isokinetic knee extensor and flexor strength and a 6-hop performance battery were assessed. Limb Symmetry Indices (LSIs) were calculated. RESULTS All PROMs significantly improved (p<0.0001). Apart from the ACL-RSI score which was significantly better (p<0.05) in the HT group at 3, 6 and 12 months, no other group differences (p>0.05) were observed. No group differences (p=0.407) were observed for knee laxity. While the HT group demonstrated significantly greater (p<0.05) quadriceps strength LSIs at 6 and 12 months, the QT group demonstrated significantly greater (p<0.05) hamstrings strength LSIs at 6, 12 and 24 months. The HT group demonstrated significantly greater (p<0.05) LSIs for the single horizontal (6 months), lateral (6 and 12 months) and medial (6 months) hop tests. CONCLUSION The HT group reported a higher level of psychological readiness to return to sport, while demonstrating greater quadriceps strength (and hop test) LSIs. Greater hamstring strength LSIs were observed for the QT cohort. Longer-term review will continue to evaluate RTS and later-stage re-injury between the two graft constructs.