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Background <p>The quadriceps tendon (QT) has emerged as a reliable autograft for anterior cruciate ligament reconstruction (ACLR), but uncertainty remains regarding several key comparative aspects—particularly donor-site morbidity, long-term graft survival, knee stability, and complication rates—when evaluated against hamstring tendon (HT) and bone–patellar tendon–bone (BPTB) autografts. High-level evidence restricted to randomized controlled trials directly comparing QT with HT or BPTB remains limited. To compare clinical outcomes, graft failure, donor-site morbidity, and knee stability among QT, HT, and BPTB autografts for primary ACLR using level-I and level-II randomized controlled trials (RCTs).</p> Methods <p>The MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases were searched on 1 September 2025, and repeated 2 weeks later. Only level-I or -II RCTs comparing QT to HT or BPTB in primary ACLR were included. Random-effects meta-analyses were performed for International Knee Documentation Committee (IKDC) and Lysholm scores, instrumented laxity, graft failure, donor-site morbidity, and reoperation. Risk of bias was assessed with RoB 2.0, and small-study effects with funnel and doi plots.</p> Results <p>Eleven RCTs (mean follow-up, 2–10&#xa0;years) were included. Pooled IKDC scores averaged 84.8 (95% CI 81.9–87.9) and Lysholm scores averaged 93.1 (95% CI 91.6–94.6), with no significant differences between QT and either comparator (<i>P</i> &gt; 0.05). Side-to-side anterior tibial translation averaged 1.2&#xa0;mm (95% CI 0.99–1.54&#xa0;mm) across all grafts, also without significant differences (<i>P</i> &gt; 0.05). Pooled graft failure and ipsilateral reoperation rates were 0.7% (95% CI 0.0–1.9%) and 2.3% (95% CI 0.6–4.7%), respectively, again with no between-graft differences (<i>P</i> &gt; 0.05). Donor-site morbidity did not differ significantly between QT and HT (mean 13.83 [95% CI 9.6–19.83]; <i>P</i> &gt; 0.05).</p> Conclusion <p>This meta-analysis of level-I/II randomized controlled trials found no statistically significant differences among quadriceps tendon, hamstring tendon, and bone–patellar tendon–bone autografts in patient-reported outcomes, knee stability, graft re-rupture, or additional knee surgery. Donor-site morbidity comparisons were limited by incomplete reporting, particularly for BPTB. These findings suggest that contemporary surgical techniques and rehabilitation protocols may minimize graft-specific differences in mid-term outcomes, although interpretation should consider the limited number of direct comparative trials across all three graft types.</p> <p><i>Level of evidence</i> Systematic review and meta-analysis; level of evidence, 1 and 2.</p>

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Clinical outcomes of quadriceps, hamstring, and bone–patellar tendon–bone autografts for ACL reconstruction: a meta-analysis of randomized controlled trials

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  • 发表日期：

    2026年5月7日

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  • Riccardo D’Ambrosi,
  • Luca Farinelli,
  • Piero Franco,
  • Andrea Marchetti,
  • Amit Meena,
  • Danko Dan Milinkovic,
  • Srinivas BS Kambhampati,
  • Luca Maria Sconfienza,
  • Thomas Patt,
  • Chiara Ursino,
  • Elisabeth Abermann,
  • Christian Fink

摘要

Background

The quadriceps tendon (QT) has emerged as a reliable autograft for anterior cruciate ligament reconstruction (ACLR), but uncertainty remains regarding several key comparative aspects—particularly donor-site morbidity, long-term graft survival, knee stability, and complication rates—when evaluated against hamstring tendon (HT) and bone–patellar tendon–bone (BPTB) autografts. High-level evidence restricted to randomized controlled trials directly comparing QT with HT or BPTB remains limited. To compare clinical outcomes, graft failure, donor-site morbidity, and knee stability among QT, HT, and BPTB autografts for primary ACLR using level-I and level-II randomized controlled trials (RCTs).

Methods

The MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases were searched on 1 September 2025, and repeated 2 weeks later. Only level-I or -II RCTs comparing QT to HT or BPTB in primary ACLR were included. Random-effects meta-analyses were performed for International Knee Documentation Committee (IKDC) and Lysholm scores, instrumented laxity, graft failure, donor-site morbidity, and reoperation. Risk of bias was assessed with RoB 2.0, and small-study effects with funnel and doi plots.

Results

Eleven RCTs (mean follow-up, 2–10 years) were included. Pooled IKDC scores averaged 84.8 (95% CI 81.9–87.9) and Lysholm scores averaged 93.1 (95% CI 91.6–94.6), with no significant differences between QT and either comparator (P > 0.05). Side-to-side anterior tibial translation averaged 1.2 mm (95% CI 0.99–1.54 mm) across all grafts, also without significant differences (P > 0.05). Pooled graft failure and ipsilateral reoperation rates were 0.7% (95% CI 0.0–1.9%) and 2.3% (95% CI 0.6–4.7%), respectively, again with no between-graft differences (P > 0.05). Donor-site morbidity did not differ significantly between QT and HT (mean 13.83 [95% CI 9.6–19.83]; P > 0.05).

Conclusion

This meta-analysis of level-I/II randomized controlled trials found no statistically significant differences among quadriceps tendon, hamstring tendon, and bone–patellar tendon–bone autografts in patient-reported outcomes, knee stability, graft re-rupture, or additional knee surgery. Donor-site morbidity comparisons were limited by incomplete reporting, particularly for BPTB. These findings suggest that contemporary surgical techniques and rehabilitation protocols may minimize graft-specific differences in mid-term outcomes, although interpretation should consider the limited number of direct comparative trials across all three graft types.

Level of evidence Systematic review and meta-analysis; level of evidence, 1 and 2.