All-Soft Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction: Short to Intermediate-Term Clinical Outcomes

Transcription

1 All-Soft Tissue Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction: Short to Intermediate-Term Clinical Outcomes William Godfrey, BS Aaron Gebrelul, BA; John Xerogeanes, MD; Ajay Premkumar, BS; Danielle Mignemi, MS, ATC, LAT, OTC

2 Background ~200,000 ACL reconstructions performed yearly 1 Reconstruction with autograft or allograft tendons Patellar Tendon Autograft Gold Standard Harvest-site morbidities Risk of patellar fracture Anterior knee pain Graft-tunnel mismatch Technical difficulty in anatomic reconstructions Hamstring Tendon Autograft Commonly utilized autograft Similar long-term outcomes to PT Less harvest site morbidity than PT Challenges Increased risk of weakness of terminal flexion and graft laxity Cross-sectional area and volume can vary greatly between patients.

3 Quadriceps Tendon Autograft Used in ~2.5-11% of ACL reconstructions 2,3 Robust graft with a large volume that is both reproducible and predictable Higher percentage of native tendon remains after harvest Initial studies show similar clinical results with less harvest site-morbidity when compared to alternative grafts

4 Autograft Quadriceps Tendon Harvest

5 Hypothesis 1. All-soft tissue quadriceps tendon autograft in ACL reconstruction yields similar shortto intermediate-term clinical outcomes and morbidity compared to alternative grafts 2. Suspensory Fixation of the autograft will have the necessary strength and security to maintain knee stability.

6 Materials and Methods Study Design Prospective, observational, non-inferiority study 200 consecutive patients were prospectively followed (Sept 2011-Jan 2014) Both primary and revision ACL reconstruction included Procedure Reconstructions performed by a single surgeon using an all-soft tissue QT autograft minimally invasive harvest with suspensory fixation Young, athletic patient population; aggressive rehabilitation protocol and no functional bracing

7 Outcome Measures International Knee Documentation Committee (IKDC) Subjective knee forms Preoperative and 1 year postoperative KT-1000 Arthrometer testing 6 weeks, 3 months, 6 months Complications Hematoma formation Arthrofibrosis Re-ruptures (graft failure)

8 Results Patient Characteristics 200 total patients; 182 primary, 18 revision IKDC Data Response Rate: 65%

9 Distribution of Difference: Pre-IKDC Post-IKDC With 95% Confidence Interval for Mean

10 Paired Profiles for Pre-IKDC vs. Post-IKDC Pre-IKDC Post-IKDC

11 Side-to-side KT-1000 Results Percent of patients w/ score 3mm 6 weeks postop: 98.4% 3 months postop: 96.1% 6 months postop: 92.7% No statistically significant change in mean difference at any time interval

12 Complication Results Relationship between complications and age Arthrofibrosis 15.9±2.9 vs 18.3±4.7 p=0.009 Graft Failure 16.8±1.7 vs 18.3±4.7 p=0.016 No statistically significant relationship exists between graft failure and graft size

13 Discussion IKDC scores similar to published data on PT and HT autografts 5-18 KT-1000 results suggest suspensory fixation appropriately supports the reconstruction Failure rate of 6.5% likely influenced by study population consistent with studies of PT and HT autografts in young, athletic patients 19

14 Conclusions All-soft tissue quadriceps tendon autograft is a viable alternative graft choice for both primary and revision ACL reconstruction This study is ongoing and continues to enroll patients to increase the cohort size for future analysis A large RCT directly comparing clinical outcomes of the QT autograft with alternative grafts would be helpful to further confirm the findings of this study.

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