Arthroscopy - 2026-06-24 - Journal Article
Similar Outcomes but Significantly Different Donor Site Morbidity Profiles After Autograft Quadriceps and Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction.
Eliasberg CD, Shamrock A, James EW, Adamec D, Wimberly A, HSS ACL Registry, Nwachukwu BU, Cordasco FA, Williams RJ, Allen AA, Marx RG, Nawabi DH
Topics
Key Takeaway
QT autograft produced less donor-site pain, numbness, and kneeling pain than BPTB but caused more quadriceps wasting/atrophy, with female QT patients showing significantly worse atrophy (estimate -2.90, p<0.0001) and a higher ipsilateral reoperation rate (26% vs 10%, p=0.016).
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Summary
This retrospective, age- and sex-matched single-institution registry study compared donor site morbidity (DSM), PROMs, RTS, and reoperation rates between QT and BPTB autograft ACLR at minimum 2-year follow-up. Total DSM scores were equivalent (87.2 vs 84.2, p=0.343), but BPTB patients had less quadriceps atrophy while QT patients had less donor-site pain, numbness, and kneeling pain. RTS rates were similar (87% QT vs 74% BPTB, p=0.093), but ipsilateral reoperation was significantly higher in the QT group (26% vs 10%, p=0.016) without a difference in graft failure rates.
Key Limitation
The unexplained 26% ipsilateral reoperation rate in the QT group, without granular data on reoperation indications, prevents meaningful interpretation of whether this reflects graft-related complications, concomitant pathology, or surgical learning curve effects.
Original Abstract
PURPOSE
To compare differences in donor site morbidity (DSM) following quadriceps tendon (QT) autograft and bone-patellar tendon-bone (BPTB) autograft anterior cruciate ligament reconstruction (ACLR) at 2 year follow-up.
METHODS
Patients who underwent primary ACLR with QT autograft between January 2018 and February 2020 were identified in a single institution registry and matched on the basis of age and sex to a control group of BPTB autograft ACLR patients. Patients were contacted at a minimum of 2 years postsurgery to evaluate DSM, Patient Reported Outcome Measures (PROMs), Return to Sport (RTS), and reoperation.
RESULTS
Fifty QT patients (mean age 22.6 years) and 88 BPTB patients (mean age 22.8 years) were included (mean follow-up 31.1 months; range 24.1-56.2). Total DSM score was similar between QT and BPTB patients (87.2 vs 84.2, P = .343); however, BPTB patients exhibited less quadriceps wasting/atrophy, but QT patients had less pain at the donor site, numbness, and pain with kneeling. Female sex was an independent predictor of inferior DSM score (Estimate: -6.4, P = .04), and quadriceps wasting/atrophy was worse in female QT than BPTB patients (Estimate: -2.90, P < .0001). There were no significant differences between QT and BPTB patients in PROMs. 87% of QT patients and 74% of BPTB patients returned to sports (P = .093). There was a higher rate of ipsilateral reoperation in the QT group compared with the BPTB group (26% vs 10%, P = .016), but no differences in reoperation for ipsilateral graft failure or contralateral ACL rupture between groups.
CONCLUSIONS
Our findings suggest that overall, the QT autograft was associated with significantly less donor site pain, numbness, and pain with kneeling, but more quadriceps wasting/atrophy than BPTB autografts in patients undergoing primary ACLR. These distinct DSM profiles, along with observed differences in quadriceps wasting/atrophy between sexes, should guide patient education accordingly.
LEVEL OF EVIDENCE
Level III, retrospective comparative case series.