KSSTA - 2026-08-17 - Journal Article
Earlier strength recovery with partial-thickness versus full-thickness quadriceps tendon graft for anterior cruciate ligament reconstruction in competitive soccer players.
Martin-Alguacil JL, Arroyo-Morales M, Lopez-Garzon M, Bolívar-Arroyo V, Cantarero-Villanueva I, Fernández-Domínguez JM, Rodriguez-Delgado JM
Topics
Key Takeaway
Partial-thickness quadriceps tendon autograft produced 26–31% greater quadriceps symmetry index at 3–6 months post-ACL reconstruction compared to full-thickness graft, with no difference at 12 months or in reinjury rate at 24 months.
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Summary
This retrospective cohort compared quadriceps strength recovery, functional outcomes, and reinjury rates between full- and partial-thickness quadriceps tendon autograft ACL reconstruction in 42 competitive soccer players over 12 months. Partial-thickness grafts demonstrated significantly faster quadriceps symmetry recovery at 3–6 months across all isokinetic velocities (60, 180, 300°/s; mean differences 26.5–31.2 points, all p<0.05), with greater early extension peak torque gains. By 12 months, both groups converged with no significant differences in any outcome, and 24-month reinjury rates were equivalent (p=0.634).
Key Limitation
The study is underpowered (n=42) with no reported group sizes, graft dimensions, or surgeon-level allocation criteria, making it impossible to exclude confounding by graft cross-sectional area, tunnel preparation technique, or patient selection bias in harvest-depth choice.
Original Abstract
PURPOSE
This study aimed to compare strength recovery, functional and clinical outcomes between full- and partial-thickness quadriceps tendon autografts for 12 months post-operatively and to examine the clinical implications of graft thickness in anterior cruciate ligament reconstruction among non-professional competitive soccer players.
METHODS
42 non-professional competitive Spanish federal soccer players who underwent primary anterior cruciate ligament reconstruction using either full- or partial-thickness quadriceps tendon grafts were included in this retrospective cohort study. Both groups followed standardised surgical and rehabilitation protocols. Evaluations were assessed preoperatively and at 3, 6 and 12 months post-operatively, with the reinjury rates recorded at 24 months. Quadriceps index, measured by isokinetic dynamometry was the primary outcome. Hamstring index, extension and flexion peak torque, single leg hop test, patient-reported outcome measures (Lysholm and Cincinnati Knee Rating System scores) and reinjury rate were evaluated as secondary outcomes. Statistical analysis was performed using repeated-measures ANCOVA with a Bonferroni adjustment, and the significance level was set at 5%.
RESULTS
During the first 6 months, faster recovery of quadriceps symmetry was observed in partial-thickness group compared to the full-thickness group at 300°/s (mean difference: -26.5, 95% confidence interval [CI] [-51.4, -1.7], p = 0.037), 180°/s (mean difference: -31.0, 95% CI [-56.0, -6.0], p = 0.017), and 60°/s (mean difference: -31.2, 95% CI [-55.4, -7.0], p = 0.013), as well as greater improvement in extension peak torque. No statistical differences (p > 0.05) remained between groups at 12 months, with both groups achieving similar recovery. Hop test and clinical outcomes improved significantly over time in both groups, without significant between-group differences (p > 0.05). Reinjury rate was similar between groups (p = 0.634).
CONCLUSIONS
Earlier strength recovery was observed with partial-thickness graft after ACL reconstruction, highlighting the clinical relevance of graft choice in early rehabilitation in competitive soccer players.
LEVEL OF EVIDENCE
Level II.