Efficacy and safety of quadriceps tendon autograft versus bone–patellar tendon–bone and hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Quadriceps tendon (QT), bone–patellar tendon–bone (BPTB), and hamstring tendon (HT) autografts are widely used for anterior cruciate ligament reconstruction (ACLR), but the optimal autograft choice remains controversial. This study assessed the treatment effects of QT versus BPTB and HT autografts for ACLR.

The PubMed, Embase, and Cochrane Library databases were systematically searched for eligible studies published from inception until July 2022. Effect estimates were presented as odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (CI) for categorical and continuous variables, respectively. All pooled analyses were performed using a random-effects model.

Twenty-one studies (3 randomized controlled trials [RCTs], 3 prospective studies, and 15 retrospective studies) involving 2964 patients with ACLR were selected for meta-analysis. Compared with the HT autograft, the QT autograft was associated with a reduced risk of graft failure (OR: 0.46; 95% CI: 0.23–0.93; P = 0.031). Compared with the BPTB autograft, the QT autograft was associated with a reduced risk of donor site pain (OR: 0.16; 95% CI: 0.10–0.24; P < 0.001). Moreover, the QT autograft was associated with a lower side-to-side difference than that observed with the HT autograft (WMD: − 0.74; 95% CI: − 1.47 to − 0.01; P = 0.048). Finally, compared with the BPTB autograft, the QT autograft was associated with a reduced risk of moderate-to-severe kneecap symptoms during sports and work activities (OR: 0.14; 95% CI: 0.05–0.37; P < 0.001).

The findings of this study suggest that the QT autograft can be defined as a safe and effective alternative choice for ACLR, but its superiority is yet to be proven by RCTs and prospective studies.

Level of evidence

Level III.