- Design
- Retrospective cohort study (level 3)
- Population
- 5653 primary ACL reconstructions, 2015 to 2022
- Primary outcome
- Non-revision reoperation and KOOS at 2 years
- Effect
- Reoperation for extension deficit or pain 11.9% (QT) vs 5.5% (HT); adjusted OR 1.96 (1.44 to 2.67)
This Swedish retrospective cohort compared 5653 primary ACL reconstructions using hamstring, patellar tendon or quadriceps tendon autografts between 2015 and 2022, looking at non-revision reoperations and KOOS scores at two years.
Quadriceps tendon grafts had the highest overall reoperation rate (19.2% vs 8.9% hamstring and 6.9% patellar tendon), driven by extension deficit or pain (11.9% vs 5.5% and 4.7%). After adjustment the association held (OR 1.96, 95% CI 1.44 to 2.67). Quadriceps graft patients were less likely to reach a minimal important change in KOOS than hamstring patients (OR 0.56). Women given larger grafts (9.5 to 12 mm) had higher odds of reoperation for extension deficit or pain (OR 1.72).
Quadriceps tendon use has grown quickly on the strength of comparable graft survival. This study suggests the cost may be in stiffness and anterior knee problems rather than graft failure.
- Discuss the higher early reoperation rate when offering a quadriceps tendon graft
- Consider graft size carefully in women; larger grafts carried more extension problems
- Prioritise full extension in early rehabilitation after quadriceps grafts
- Revision and graft failure were not studied here; these data are about stiffness and pain
Why it matters
It is the largest signal yet of a trade-off for a graft many surgeons have switched to.
Don't overread it
This is a single-centre retrospective cohort; surgeon learning curve with quadriceps grafts may explain part of the difference.
The statistics, in plain English
An adjusted odds ratio of 1.96 means about double the odds after accounting for measured differences between patients. Unmeasured factors, such as surgeon experience, may remain.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for orthopaedics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free