Arthroscopy - 2026-03-25 - Journal Article; Review
Quadriceps Tendon Autograft Produces Favorable Return to Sport, Strength, Range of Motion, Retear Rate, and Midterm Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review.
Hopper HM, Harris M, Wyatt P, Cyrus J, Smith M, O'Neill CN, Edge C, Goodloe JB, Vap AR, Amendola A
Topics
Key Takeaway
Quadriceps tendon autograft ACLR demonstrates graft failure rates of 0–24% and anterior knee pain rates of 0–5% at 5–23 year follow-up across 662 reconstructions.
Summary Depth
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Summary
This systematic review evaluated midterm and long-term outcomes of QT autograft ACLR with minimum 5-year follow-up across 8 studies and 662 reconstructions. Outcomes assessed included strength, ROM, hop tests, laxity, patient-reported outcomes, return to sport, and complications. Graft failure ranged 0–24%, ipsilateral reoperation 3–35.3%, contralateral ACLR 5.4–23.5%, donor site pain 0–11.5%, and anterior knee pain 0–5%.
Key Limitation
Extreme heterogeneity across only 8 included studies with wide complication ranges (e.g., graft failure 0–24%) prevents definitive quantitative conclusions about true failure rates.
Original Abstract
PURPOSE
To determine the outcomes of anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) graft with a minimum of 5-year follow-up.
METHODS
A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane, Embase, and Medline databases were searched for studies published through May 2025. Inclusion criteria were studies that included ACLR with QT autograft with a minimum of 5-year follow-up. Studies investigating anterior cruciate ligament repairs and studies that did not separate analyses by graft type were excluded. Non-English studies, systematic reviews, technical notes, letters to the editor, and surgical technique papers were also excluded. Risk of bias was assessed using Joanna Briggs Institute's Methodological Quality Assessment Tool. Outcomes of interest included strength, range of motion (ROM), hop tests, joint laxity, patient-reported outcomes, return to sport, and complications.
RESULTS
Eight heterogeneous studies including 662 ACLRs utilizing QT graft with follow-ups ranging from 5 to 23 years were included in this review. Favorable outcomes reported in these studies included strength, ROM, hopping, joint laxity, patient-reported outcomes, return to sport, and complications. The complication rates ranged from 0% to 24% for graft failure, 3% to 35.3% for ipsilateral reoperations for reasons other than graft failure, 5.4% to 23.5% for contralateral ACLR, 0% to 11.5% for patients with donor graft site pain, 0% to 5% for anterior knee pain, and 0% to 1.5% for infection.
CONCLUSIONS
Overall, this systematic review has shown that the QT graft produces good midterm outcomes and is a viable graft choice for patient strength, joint laxity, return to sport, ROM, and patient-reported outcomes. This study found higher rates of graft failure and ROM deficits but lower rates of anterior knee pain compared with studies examining outcomes of ACLR with QT graft with a minimum 2-year follow-up supporting the need for longer outcome studies to further define the longevity of the QT graft.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II to IV studies.