Bone-Patellar Tendon-Bone Versus Quadriceps Tendon-Bone Autografts in Anatomic Rectangular Tunnel Anterior Cruciate Ligament Reconstruction.

Background: Anatomic rectangular tunnel anterior cruciate ligament reconstruction (ART-ACLR) can mimic the fiber arrangement of the native ACL and restore normal knee biomechanics, compared with the conventional round tunnel ACLR. ART-ACLR using a bone-patellar tendon-bone (BPTB) graft can provide satisfactory clinical outcomes; however, some issues such as secondary ACL injury and donor-site morbidity, including postoperative anterior knee pain (AKP), remain to be solved. Due to these issues, quadriceps tendon-bone (QTB) grafts have recently become more popular.

Purpose: To compare the 2-year clinical outcomes of ART-ACLR with BPTB and QTB autografts.

Study Design: Cohort study; Level of evidence, 3.

Methods: A total of 134 patients underwent primary ART-ACLR with BPTB (n = 70) or QTB (n = 64). All patients had a minimum follow-up period of 2 years postoperatively. Outcome evaluations included the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), side-to-side differences (SSDs) with the KT-1000 knee arthrometer, rate of secondary ACL injury, and incidence of AKP.

Results: Regarding age, sex, height, weight,and concomitant procedures, there were no significant differences between the 2 groups. All clinical scores significantly improved from preoperatively to 6 months postoperatively and further increased throughout the 2-year postoperative period in both groups. The IKDC and all subscales of the KOOS, except Sport and Recreation, were equivalent between the BPTB and QTB groups at each postoperative time point. There were no significant differences in the SSD value of KT-1000 arthrometer between the 2 groups. The rates of secondary ACL injury were 10.0% on the ipsilateral side and 2.9% on the contralateral side in the BPTB group and 3.1% on the ipsilateral side and 4.7% on the contralateral side in the QTB group, with no significant difference between both groups. The incidence of AKP was 17.1% and 4.9% in the BPTB group and QTB group, respectively, with significance of = .02).

Conclusion: The clinical scores, SSD value of the KT-1000 arthrometer, and secondary ACL injury rates were equivalent between the BPTB and QTB groups. However, the incidence of AKP was significantly lower in the QTB group, suggesting that QTB could be a favorable graft for ACLR.