QUADRICEPS AUTOGRAFT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A LITERATURE REVIEW

ABSTRACT Introduction: Anterior cruciate ligament injury is one of the most prevalent musculoskeletal injuries. Therefore, several surgical techniques and graft types have been described for its reconstruction. Autologous hamstring tendon graft is one of the most frequently used, but use of the quadriceps tendon graft has gained prominence in recent years. Objective: To review the literature to compare the outcomes of patients undergoing anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft versus hamstring tendon (HT) autograft. Methods: A literature review was conducted through PubMed to locate studies (Level of evidence I-III) comparing the outcomes of the QT autograft vs. the HT autograft in patients undergoing primary ACL reconstruction. Patients were assessed on the basis of re-rupture rate, ligament instability, patient-reported outcome scores, previous pain, and isokinetic tests. Results: Six studies were selected according to inclusion criteria. A total of 481 patients were evaluated, 243 in the QT group and 238 in the HT group. The total re-rupture rate was 1.6% (8 of 481), with 6 in the HT group and 2 in the QT group, but with no statistical difference between groups. One study found increased ligament instability in the HT group and another study found greater instability in the QT group, both with statistical significance. Regarding the patient-reported functional scores, only 01 study found statistical difference, with better results in the QT group. There was no difference in previous pain between groups in the selected studies. Regarding the isokinetic test, one study found a difference in flexor force in the HT group (p <0.01), with no difference in extensor force, while another two studies found an increased extensor force deficit in the QT group within up to 01 year of follow-up. The flexor/ extensor muscle strength ratio was higher in the QT group in both studies. Conclusion: ACL reconstruction with QT graft presents re-rupture rates, ligament instability, functional scores and donor site morbidity that are similar to the HT graft, in addition to preserving greater flexor force in proportion to extensor force. Level of evidence: IV; Review study.

摘要 引言：前交叉韧带（anterior cruciate ligament, ACL）损伤是最常见的肌肉骨骼损伤之一。目前已有多种手术技术及移植物类型用于其重建治疗。自体腘绳肌腱移植物是临床最常用的移植物之一，而近年来自体股四头肌腱移植物的应用逐渐受到关注。目的：本研究旨在通过文献综述，对比接受股四头肌腱（quadriceps tendon, QT）自体移植物与腘绳肌腱（hamstring tendon, HT）自体移植物行前交叉韧带重建（anterior cruciate ligament reconstruction, ACLR）患者的术后结局。方法：本研究通过PubMed数据库开展文献综述，检索纳入针对接受初次ACL重建的患者，对比QT自体移植物与HT自体移植物术后结局的研究（证据等级I~III）。评估指标包括再断裂率、韧带不稳情况、患者报告结局评分、供区疼痛及等速肌力测试结果。结果：最终根据纳入标准筛选出6项研究，共纳入481例患者，其中QT组243例，HT组238例。总体再断裂率为1.6%（481例中共8例），HT组6例，QT组2例，两组间差异无统计学意义。1项研究显示HT组韧带不稳程度更高，另有1项研究显示QT组不稳程度更显著，两项结果均具有统计学意义。在患者报告的功能评分方面，仅1项研究发现两组间存在统计学差异，QT组评分更优。纳入研究中两组间供区疼痛程度无显著差异。关于等速肌力测试，1项研究显示HT组屈肌肌力存在显著差异（p<0.01），伸肌肌力无差异；另有2项研究显示，在最长1年的随访期内，QT组伸肌肌力缺损程度更显著。两项研究均显示QT组屈肌/伸肌肌力比值更高。结论：采用QT移植物行ACL重建的患者，其再断裂率、韧带不稳情况、功能评分及供区并发症发生率与HT移植物相当，且可保留更优的屈肌与伸肌肌力比例。证据等级：IV级；综述类研究。