Similar strength recovery but more complications with Bone‐Quadriceps Tendon Autograft compared to Quadriceps Tendon Autograft in anterior cruciate ligament reconstruction in competitive soccer players

Abstract

Purpose: This study aimed to evaluate the clinical and functional outcomes, as well as the associated morbidity, of anterior cruciate ligament (ACL) reconstruction using quadriceps tendon grafts, with and without bone block.

Methods: This prospective cohort study involved 52 competitive Spanish federal soccer players aged 16–40. This study compared the outcomes of ACL reconstruction using Bone-Quadriceps Tendon Autograft (BQTA) and Quadriceps Tendon Autograft (QTA). Functional, clinical and patient-reported outcomes were assessed preoperatively and at 3-, 6- and 12-month postoperative intervals. Both groups followed standardized surgical and rehabilitation protocols. Statistical analyses were performed to identify differences in recovery patterns and morbidity, thereby providing insights into the optimal graft selection tailored to patient-specific needs and activity levels.

Results: A total of 52 patients with ACL injuries were evaluated. No significant differences were observed in the outcomes at the final follow-up. Key metrics such as the Lysholm Knee Score (mean difference = 1.2, 95% CI: [−0.8, 3.2], p = 0.21), Visual Analogue Scale for pain (mean difference = 0.3, 95% CI: [−0.5, 1.1], p = 0.68), peak torque, hamstring/quadriceps ratios and Limb Symmetry Index showed no significant differences between the groups. Notably, 2 patellar fractures and one quadriceps tendon avulsion occurred in the BQTA, highlighting the higher morbidity associated with this particular graft.

Conclusion: Similar functional and clinical results were observed with BQTA and QTA after ACL reconstruction in football players. Major complications were associated with the extraction of the bone block exclusively in the BQTA, which can guide the surgeon in choosing the type of quadriceps graft.