Quadriceps Tendon Versus Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Background: Autograft choice in anterior cruciate ligament reconstruction (ACLR) remains controversial, with increasing interest in the usage of quadriceps tendon (QT) autograft versus traditional hamstring tendon (HT) use. The current study undertakes an in-depth review and comparison of the clinical and functional outcomes of QT and HT autografts in ACLR. Hypothesis: The QT autograft is equivalent to the HT autograft and there will be little or no significant difference in the outcomes between these 2 autografts. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The PUBMED, EMBASE, MEDLINE, and CENTRAL databases were systematically searched from their inception until November 2020. All observational studies comparing ACLR QT and HT autografts were assessed for their methodological quality. Patient outcomes were compared according to patient-reported outcome measures (International Knee Documentation Committee [IKDC], Cincinnati, Lysholm, Tegner, and visual analog scale [VAS] measures), knee extensor and flexor torque limb symmetry indices (LSIs), hamstring to quadriceps (H/Q) ratios, functional hop capacity, knee laxity, ipsilateral graft failure, and contralateral injury. Results: A total of 20 observational studies comprising 28,621 patients (QT = 2550; HT = 26,071) were included in the quantitative meta-analysis. In comparison with patients who received an HT autograft, those who received a QT autograft had similar postoperative Lysholm (mean difference [MD], 0.67; P =.630), IKDC (MD, 0.48; P =.480), VAS pain (MD, 0.04; P =.710), and Cincinnati (MD, -0.85; P =.660) scores; LSI for knee flexor strength (MD, 6.06; P =.120); H/Q ratio (MD, 3.22; P =.160); hop test LSI (MD, -1.62; P =.230); pivot-shift test grade 0 (odds ratio [OR], 0.80; P =.180); Lachman test grade 0 (OR, 2.38; P =.320), side-to-side laxity (MD, 0.09; P =.650); incidence of graft failure (OR, 1.07; P =.830) or contralateral knee injury (OR, 1.22; P =.610); and Tegner scores (MD, 0.11; P =.060). HT autografts were associated with a higher (better) side-to-side LSI for knee extensor strength (MD, -6.31; P =.0002). Conclusion: In this meta-analysis, the use of the QT autograft was equivalent to the HT autograft in ACLR, with comparable graft failure and clinical and functional outcomes observed. However, HT autografts were associated with better LSI knee extensor strength.