KSSTA - 2026-03-03 - Journal Article; Review
Comparative outcomes of full-, partial- and superficial quadriceps tendon grafts in anterior cruciate ligament reconstruction: A PRISMA systematic review.
Jaafreh Alhabashneh AKA, Prizov AP, Lutsenko AM, Lazishvili GD, Karpenko AV, Lazko FL, Airapetov GA, Zagorodnii NV
Topics
Key Takeaway
Full-thickness quadriceps tendon grafts achieve 0–5.1% failure rates and KT-1000 side-to-side difference of 0.6–1.3 mm but cause 26–31% isokinetic quadriceps strength deficits, while partial-thickness grafts show only 2.3% failure with minimal strength loss across 13 studies and 427 patients.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This PRISMA 2020 systematic review compared failure rates, knee stability, and patient-reported outcomes among full-thickness (F-QT, n=342), partial-thickness (P-QT, n=57), and isolated rectus femoris (RF, n=28) quadriceps tendon ACL autografts from studies published 2019–2025. F-QT grafts demonstrated 90.7–100% negative Lachman and ΔIKDC of +39.4 but incurred 26–31% isokinetic quadriceps deficits and 6–12.5% arthrofibrosis rates. RF grafts carried the highest failure rate at 7.1%, while P-QT grafts balanced a 2.3% failure rate with preserved quadriceps strength.
Key Limitation
The RF graft cohort (n=28 across multiple studies) is far too small to draw reliable conclusions about its 7.1% failure rate, which is the review's most clinically alarming finding.
Original Abstract
PURPOSE
Quadriceps tendon (QT) autografts are favoured in anterior cruciate ligament (ACL) reconstruction for their biomechanical properties, yet outcomes among variants-full-thickness (F-QT), partial-thickness (P-QT) and isolated rectus femoris (RF) grafts-remain unclear. The primary aim was to compare failure rates and knee stability among all-soft tissue QT graft variants.
METHODS
Following PRISMA 2020 guidelines, four databases were searched from inception through June 2025. Included studies (published 2019-2025) reported outcomes for F-QT, P-QT, or RF grafts. After screening 2214 records, 13 studies (n = 427 patients) with a mean follow-up of 24-48 months (level of evidence I-IV) were included. Risk of bias was assessed via the National Heart, Lung and Blood Institute (NHLBI) tools.
RESULTS
F-QT grafts (n = 342) showed low failure (0%-5.1%), excellent stability (KT-1000: 0.6-1.3 mm; 90.7%-100% negative Lachman) and improved patient-reported outcome measures (ΔIKDC: +39.4; ΔLysholm: +33.6) but had significant quadriceps deficits (↓26%-31% isokinetic performance). Complications included haematoma (12%) and arthrofibrosis (6%-12.5%). P-QT grafts (n = 57) had minimal strength deficits and a 2.3% failure rate. RF grafts (n = 28) showed a 7.1% failure rate. No infections or fractures were reported.
CONCLUSION
F-QT autografts provide reliable stability. Evidence suggests P-QT grafts may better preserve quadriceps strength, while RF grafts appear to carry a higher failure risk. Long-term evidence remains limited, necessitating further high-quality comparative studies.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I-IV studies.