Arthroscopy - 2026-04-07 - Journal Article; Review
Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Versus Quadriceps Tendon Autograft Results in No Significant Differences in Patient-Reported Outcome Measures, Re-Rupture Rates, and Clinical Stability: A Meta-analysis of Level I Randomized Control Trials.
Davey MS, Hurley ET, Doyle TR, Dickens JF
Topics
Key Takeaway
Meta-analysis of 6 RCTs (n=374) found no significant difference between hamstring and quadriceps tendon autografts in re-rupture rate (RR 1.03, p=0.96), pivot-shift positivity (RR 0.42, p=0.42), IKDC, or Lysholm scores, with one study suggesting lower donor-site morbidity with quadriceps tendon.
Summary Depth
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Summary
This meta-analysis of 6 Level I RCTs compared hamstring tendon (n=186) versus quadriceps tendon (n=188) autograft ACLR in patients with mean age 26.7 years. No significant differences were found in re-rupture rate (RR 1.03, p=0.96), pivot-shift positivity (RR 0.42, p=0.42), IKDC (MD 0.00, p=0.98), or Lysholm scores (MD -0.21, p=0.47). One included RCT identified lower donor-site morbidity scores with quadriceps tendon autograft.
Key Limitation
Follow-up duration is short and inconsistently reported across included RCTs, precluding conclusions about graft durability, osteoarthritis progression, or late re-rupture rates.
Original Abstract
PURPOSE
To perform a systematic review and meta-analysis of Level I randomized controlled trials (RCTs) examining the clinical outcomes of patients who underwent anterior cruciate ligament reconstruction (ACLR), with hamstring tendon (HT) versus quadriceps tendon (QT) autografts.
METHODS
A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only RCTs of Level I evidence comparing clinical outcomes of ACLR with HT versus QT autografts were included. Descriptive statistics were performed with risk ratios utilized for dichotomous variables and the mean difference (MD) for continuous variables. Statistical significance was set at P-value < .05.
RESULTS
There were 6 RCTs including 374 patients (60% males) with a mean age of 26.7 ± 3.8 years who underwent ACLR with HT (n = 186) or QT (n = 188) autografts. Meta-analysis found there were no significant differences between those who underwent ACLR with either HT or QT autografts with respect to positive pivot-shift testing (risk ratio; 0.42, P = .42) and re-rupture rates (risk ratio; 1.03, P = .96). Similarly, there was no significant difference between the groups for all patient-reported outcome measures, namely International Knee Documentation Committee scores (MD; 0.00, P = .98) and Lysholm scores (MD; -0.21, P = .47) (MD; -0.18, P = .65). However, one study found a significant difference between the HT and QT groups with respect to donor site morbidity scores).
CONCLUSIONS
Current Level I evidence suggests that there is no significant difference between ACLR with HT or QT autografts in re-rupture rates, clinical evaluation of laxity, or patient-reported outcomes measures in the short-term postoperatively. Although few RCTs reported specifically in relation to donor site morbidity, current literature suggests that QT autograft may potentially result in significantly lower occurrence of donor site morbidity scoring.
LEVEL OF EVIDENCE
Level I, meta-analysis of Level I studies.