Central quadriceps tendon graft effective for ACL reconstruction with excellent functional outcomes: study

Anterior cruciate ligament (ACL) injuries are common, particularly among athletes, and often result in knee instability and decreased functionality. Arthroscopic ACL reconstruction is the standard treatment, typically using a patellar tendon bone graft (PTBG) or hamstring tendon graft (HTG). The central quadriceps tendon graft (QTG) has been proposed as a superior alternative due to its structural properties.

Ambareesh P et al conducted a study involving patients undergoing ACL reconstruction using the central quadriceps tendon graft. Functional outcomes were assessed using the Tegner Lysholm knee score at preoperative and postoperative intervals of two weeks, three months, and six months. Statistical analysis compared these scores over time.

The study was conducted at Vydehi institute of medical sciences and research centre, Bengaluru, Karnataka. It has been published in Cureus journal.

Key findings of the study were:

• In the study, 62.5% were in the age group <30 years, 25.0% were in the age group 31 to 40 years, and 12.5% were in the age group >40 years.

• The most common mode of injury was sports injury and road traffic accidents (RTA) accounting for 46.9% of the subjects, while only 6.2% of the subjects reported falling from height.

• Among the subjects, 90.6% were male and 9.4% were female.

• Right-side injuries were more prevalent (65.6%).

• The mean time from injury to surgery was 9.37 months.

• The mean graft size was 8.75 mm, and the mean tourniquet time was 105.94 minutes.

• Preoperative tests showed positive results for anterior drawer, Lachman, and pivot shift tests in most patients, which were negative postoperatively.

• Significant improvements in knee flexion and Lysholm knee scores were observed.

• Preoperative knee flexion ranged from 0-100° to 0-120°, improving to 0-120° to 0-130° six months postoperatively. The mean Lysholm knee score improved from 47.06 preoperatively to 93.16 at six months.

• Excellent outcomes were seen in 78.1% of the patients, with 21.9% achieving good outcomes.

The authors concluded that – “The central quadriceps tendon graft is an effective option for ACL reconstruction, offering excellent functional outcomes and low complication rates. It shows promise as a better alternative to traditional graft types, although further research is necessary to confirm these findings.”

Further reading:

Parameshwar A, Kumar L, Donthi S R, et al. (July 25, 2024) Analysis of the Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using the Central Quadriceps Tendon Graft.

Cureus 16(7): e65351. doi:10.7759/cureus.65351