Quadriceps Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction Has No Difference in Short‐Term Clinical Outcomes Between All‐Soft Tissue Versus Tendon–Bone Grafts: A Systematic Review

Purpose To compare clinical outcomes and complications after primary anterior cruciate ligament reconstruction with all‐soft tissue quadriceps tendon (ST‐QT) versus quadriceps tendon‐bone (QT–B) autograft. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines by searching PubMed, Embase, and Cochrane Library to identify studies directly comparing outcomes of primary anterior cruciate ligament reconstruction with ST‐QT versus QT–B autograft. Outcomes included rates of graft failure and other complications, patient‐reported outcomes, return to sport, anteroposterior knee laxity, pivot shift testing, and the Objective International Knee Documentation Committee score. Results Five studies (1 Level II, 4 Level III) met the inclusion criteria, including a total of 996 knees undergoing anterior cruciate ligament reconstruction with ST‐QT autograft and 1279 with QT–B autograft. Mean age at surgery ranged from 20.3 to 31.7 years. Minimum follow‐up time ranged from 12.0 to 24.0 months. The overall percentage of men ranged from 48.8% to 84.6%. Graft failure ranged from 2.4% to 7.6% of patients in the ST‐QT autograft group and 3.3% to 6.4% in the QT–B autograft group. No study found a significant difference in graft failure rates between the 2 groups. Intraoperative patellar fracture occurred in 2 cases overall, both in the QT–B group. No studies found a significant difference in return to sport between groups. One study found significantly better Knee Injury and Osteoarthritis Outcome Score subscale scores in the ST‐QT group. One study found a significantly greater proportion of ST‐QT patients showing a positive pivot shift postoperatively. No other significant differences were found for the remaining patient‐reported outcomes between groups. Conclusions Current comparative evidence suggests ST‐QT and QT–B autografts for primary anterior cruciate ligament reconstruction yield similar short‐ to midterm outcomes, though limited studies and follow‐up warrant cautious interpretation. Patellar fracture remains an uncommon QT–B risk. Level of Evidence Level III, systematic review of Level II and III studies.