06.05.14
The use of quadriceps tendon bone grafts during anterior cruciate ligament (ACL) reconstruction resulted in less kneeling pain, graft site pain and sensitivity loss compared with the use of bone-patellar tendon-bone grafts, according to the results of a recent study.
Researchers included 51 patients with isolated ACL injuries and randomly assigned 25 patients to receive bone-patellar tendon-bone (BPTB) grafts and 26 patients to had quadriceps tendon bone (QTB) grafts. Follow-up evaluations were performed at one year and two years. Researchers assessed anterior knee pain clinically and by knee-walking ability. Patients also were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and a KT-1000 arthrometer (MEDmetric; San Diego, Calif.).
The investigators found similar anterior knee laxity in groups at follow-up, while 14 percent of patients in the QTB group had positive pivot shift test results vs. 38 percent in the BPTB group. Patients in the QTB group experienced significantly less anterior kneeling pain, with 7 percent of patients grading knee walking as difficult or impossible compared with 34 percent in the BPTB group. Researchers found no difference between the groups in subjective outcomes at one-year and two-year follow-ups.
“Overall, the data from the present level II study confirms the findings of previous retrospective studies that QTB grafts have several advantages over BPTB grafts, especially with respect to donor site morbidity and sensory loss, but maybe also regarding knee stability,” researchers wrote in the study conclusion. “QTB grafts should be considered as a graft choice for primary ACL reconstruction for patients in whom donor site morbidity problems might significantly influence the final outcome. This could include patients with a need for kneeling activities at work or for recreational or religious reasons.”
Researchers included 51 patients with isolated ACL injuries and randomly assigned 25 patients to receive bone-patellar tendon-bone (BPTB) grafts and 26 patients to had quadriceps tendon bone (QTB) grafts. Follow-up evaluations were performed at one year and two years. Researchers assessed anterior knee pain clinically and by knee-walking ability. Patients also were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and a KT-1000 arthrometer (MEDmetric; San Diego, Calif.).
The investigators found similar anterior knee laxity in groups at follow-up, while 14 percent of patients in the QTB group had positive pivot shift test results vs. 38 percent in the BPTB group. Patients in the QTB group experienced significantly less anterior kneeling pain, with 7 percent of patients grading knee walking as difficult or impossible compared with 34 percent in the BPTB group. Researchers found no difference between the groups in subjective outcomes at one-year and two-year follow-ups.
“Overall, the data from the present level II study confirms the findings of previous retrospective studies that QTB grafts have several advantages over BPTB grafts, especially with respect to donor site morbidity and sensory loss, but maybe also regarding knee stability,” researchers wrote in the study conclusion. “QTB grafts should be considered as a graft choice for primary ACL reconstruction for patients in whom donor site morbidity problems might significantly influence the final outcome. This could include patients with a need for kneeling activities at work or for recreational or religious reasons.”