Quadriceps Tendon versus Bone–Patellar Tendon–Bone Autograft for Primary ACL Reconstruction: A Systematic Review and Meta-analysis of Complications and Patient-Reported Outcomes

Abstract

Background: Bone–patellar tendon–bone has long been regarded as a benchmark graft for primary anterior cruciate ligament reconstruction, although donor-site morbidity remains a relevant limitation. Quadriceps tendon has emerged as an increasingly adopted alternative, but its comparative role remains to be clearly defined.

Objectives: This systematic review and meta-analysis aimed to compare quadriceps tendon and bone–patellar tendon–bone autografts in primary anterior cruciate ligament reconstruction, particularly regarding patient-reported outcomes, graft failure, and postoperative complications.

Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched for comparative studies evaluating quadriceps tendon versus bone–patellar tendon–bone autografts in primary anterior cruciate ligament reconstruction.

Discussion: Six comparative studies met the eligibility criteria. Pooled analyses showed no significant differences between grafts in International Knee Documentation Committee subjective score, Tegner activity score, Lysholm score, or graft failure. In contrast, quadriceps tendon was associated with a lower rate of arthrofibrosis. A lower risk of contralateral anterior cruciate ligament tear was also observed, although this finding should be interpreted cautiously because of sparse event counts.

Conclusion: Quadriceps tendon offers clinical effectiveness comparable to bone–patellar tendon–bone, with a potentially more favorable complication profile, supporting its use as a dependable alternative graft for primary anterior cruciate ligament reconstruction.

Keyword: anterior cruciate ligament reconstruction, autograft, bone–patellar tendon–bone, quadriceps tendon, systematic review

Latar belakang: Bone–patellar tendon–bone merupakan graft acuan pada rekonstruksi ligamentum krusiatum anterior primer, tetapi morbiditas donor-site tetap menjadi perhatian. Quadriceps tendon semakin banyak digunakan sebagai alternatif, namun efektivitas dan profil komplikasinya masih perlu dipertegas.

Tujuan: Systematic review dan meta-analysis ini bertujuan membandingkan autograft quadriceps tendon dan bone–patellar tendon–bone pada rekonstruksi ligamentum krusiatum anterior primer, terutama terkait luaran pasien, kegagalan graft, dan komplikasi pascaoperasi.

Metode: Studi ini dilakukan sesuai Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Scopus, Web of Science, dan Cochrane CENTRAL digunakan untuk mencari studi komparatif yang mengevaluasi quadriceps tendon versus bone–patellar tendon–bone pada rekonstruksi ligamentum krusiatum anterior primer.

Pembahasan: Enam studi komparatif memenuhi kriteria inklusi. Analisis gabungan menunjukkan tidak ada perbedaan bermakna pada International Knee Documentation Committee subjective score, Tegner activity score, Lysholm score, maupun kegagalan graft. Sebaliknya, quadriceps tendon berhubungan dengan angka arthrofibrosis yang lebih rendah. Penurunan risiko robekan ligamentum krusiatum anterior kontralateral juga ditemukan, tetapi perlu ditafsirkan hati-hati karena jumlah kejadian yang terbatas.

Kesimpulan: Quadriceps tendon memberikan efektivitas klinis yang sebanding dengan bone–patellar tendon–bone, dengan potensi profil komplikasi yang lebih menguntungkan, sehingga dapat digunakan sebagai alternatif graft yang andal pada rekonstruksi ligamentum krusiatum anterior primer.

Kata kunci: autograft; bone–patellar tendon–bone; quadriceps tendon; rekonstruksi ligamentum krusiatum anterior; systematic review