Knee Surg Sports Traumatol Arthrosc. 2026 Jan 21. doi: 10.1002/ksa.70275. Online ahead of print.
ABSTRACT
PURPOSE: Dynamic tibiofemoral movements following anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autografts have not yet been compared to other autografts. We aimed to compare dynamic anterior tibial translation (ATTd) and internal tibial rotation (ITRd) during jump-landing and walking among patients with QT, bone-patellar tendon-bone (BPTB) and hamstrings tendon (HT) autografts at mid-term follow-up. The secondary aim was to compare lower extremity strength among autografts.
METHODS: Patients were included from a previous randomized controlled trial (randomly received primary ACLR with a QT, BPTB or HT autograft), and were prospectively assessed for additional analyses. Primary outcome measures were side-to-side differences in ATTd and ITRd during the side hop, single-leg hop for distance, triple hop for distance, double-leg drop-jump and walking, measured using 3D optoelectronic motion capture, and statistically analyzed using statistical parametric mapping. Moreover, isometric hamstrings and quadriceps strength limb symmetry index (LSI) were assessed using a dynamometer.
RESULTS: Thirty patients were included at 4.7 ± 1.8 years (range: 1.4-7.2) post-ACLR (n = 10 per autograft; age: 31.0 ± 4.8 years). No significant between-group differences were observed for side-to-side difference in ATTd and ITRd during all dynamic tasks (p > 0.05). QT and BPTB autograft groups demonstrated greater isometric hamstrings strength LSI (QT = 98.4% vs. BPTB = 99.3% vs. HT = 79.0%; p = 0.02) and greater hamstrings/quadriceps strength ratio LSI (QT = 102.0% vs. BPTB = 104.6% vs. HT = 79.6%; p = 0.01) compared to the HT autograft, but quadriceps strength was similar among autografts.
CONCLUSIONS: Patients who underwent ACLR with QT autografts demonstrated similar side-to-side differences in ATTd and ITRd compared to patients with BPTB and HT autografts 5 years post-ACLR, without demonstrating graft-harvest-related strength deficits, whereas patients with HT autografts showed persistent hamstrings weakness. Graft selection should consider persistent hamstrings strength deficits in patients with HT autografts, while ATTd and ITRd are not autograft-dependent. These findings support QT autografts as a viable option for ACLR.
LEVEL OF EVIDENCE: Level II.
PMID:41562143 | DOI:10.1002/ksa.70275
