Clinical Outcomes of All-Soft Tissue Quadriceps Tendon Autograft for - PowerPoint PPT Presentation

Clinical Outcomes of All-Soft Tissue Quadriceps Tendon Autograft for Revision Anterior Cruciate Ligament Reconstruction Janelle Prince MSAT, LAT, ATC, OTC PI: John Xerogeanes, MD

Background

Objectives The purpose of this study was to examine early and intermediate clinical outcomes of the all soft tissue quadriceps tendon autograft when used for revision ACL reconstructions Alternate QT Autograft QT Autograft Autografts (Primary) (Revision) (Revision)

Methodology • Retrospective chart review • Prospectively followed 100 patients undergoing revision ACL reconstruction with a quadriceps tendon autograft • All surgeries were performed by single surgeon • Standard post-op protocol • Outcomes collected as post-op standard of care

Surgical Technique

Methodology • Outcomes • Self reported function (IKDC) • Knee laxity (KT 1000) • Limb strength symmetry (Biodex) • Complication rate

Participants • 100 patients that underwent revision ACL reconstruction with QT autograft

Results • Average follow up= 42.2 ± 21.2 months • 80% response rate to follow up survey • IKDC scores improved significantly • KT 1000 not statistically significant over time • Strength improved significantly over time • Overall complication rate= 18%

Results- Subjective Function • IKDC improved significantly from 54.3 to 82.8 (p<0.001)

Results- Knee Laxity

Results- Strength

Results- Complications • 11% failure rate, 5% revision rate • 13% of patients returned to OR for various complications

Conclusion • Acceptable intermediate term clinical outcomes

References 1. Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ. The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med. 2006;34(1):128-135. 2. Arianjam A, Inacio MCS, Funahashi TT, Maletis GB. Analysis of 2019 Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction From a Community- Based Registry. Am J Sports Med. 2017:363546517700882. 3. Ashford WB, Kelly TH, Chapin RW, Xerogeanes JW, Slone HS. Predicted quadriceps vs. quadrupled hamstring tendon graft size using 3-dimensional MRI. Knee. 2018;25(6):1100- 1106. 4. Carson EW, Anisko EM, Restrepo C, Panariello RA, O'Brien SJ, Warren RF. Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. The journal of knee surgery. 2004;17(3):127-132. 5. Cavaignac E, Coulin B, Tscholl P, Nik Mohd Fatmy N, Duthon V, Menetrey J. Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years. Am J Sports Med. 2017;45(6):1326-1332. 6. Daniel DM, Stone ML, Sachs R, Malcom L. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med. 1985;13(6):401-407. 7. Dauty M, Menu P, Fouasson-Chailloux A, Dubois C. Muscular isokinetic strength recovery after knee anterior cruciate ligament reconstruction revision: Preliminary study. Annals of Physical and Rehabilitation Medicine. 2014;57(1):55-65. 8. Dauty M, P. Menu, A. Fouasson-Chailloux, C. Dubois. Muscular isokinetic strength recovery after knee anterior cruciate ligament reconstruction revision: preliminary study. Annals of Physical and Rehabilitation Medicin. 2013;57(2014):55-65. 9. DeHaven KE, Cosgarea AJ, Sebastianelli WJ. Arthrofibrosis of the knee following ligament surgery. Instr Course Lect. 2003;52:369-381. 10. Eberhardt C, A. H. Kurth, N. Hailer, A. Jäger. Revision ACL Reconstruction using autogenous patellar tendon graft. Knee Surg, Sports Traumatol, Arthosc. 2000;8:290-295. 11. Eberhardt C, Kurth AH, Hailer N, Jäger A. Revision ACL reconstruction using autogenous patellar tendon graft. Knee Surg Sports Traumatol Arthrosc. 2000;8(5):290-295. 12. Ferretti A, Monaco E, Caperna L, Palma T, Conteduca F. Revision ACL reconstruction using contralateral hamstrings. Knee Surg Sports Traumatol Arthrosc. 2013;21(3):690-695. 13. Fischer F, Fink C, Herbst E, et al. Higher hamstring-to-quadriceps isokinetic strength ratio during the first post-operative months in patients with quadriceps tendon compared to hamstring tendon graft following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017. 14. Garofalo R, A. Djahangiri, and O. Siegrist. Revision Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon-Patellar Bone Autograft. The Journal of Arthroscopic and Related Surgery. 2006;22(2):205-214. 15. Garofalo R, Djahangiri A, Siegrist O. Revision anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arthroscopy. 2006;22(2):205-214. 16. Geib TM, Shelton WR, Phelps RA, Clark L. Anterior Cruciate Ligement Reconstruction Using Quadriceps Tendon Autograft: Intermediate-Term Outcome. The Journal of Arthroscopic and Related Surgery. 2009;25(12):1408-1414. 17. Hamner DL, et al. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am. 1999;81(4):549-557. 18. Han HS, et al.,. Anterior Cruciate Ligament Reconstruction. Clin Orthop Relat Res. 2008;466(1):198-204. 19. Han HS, Seong SC, Lee S, Lee MC. Anterior Cruciate Ligament Reconstruction. Clin Orthop Relat Res. 2008;466(1):198-204. 20. Han HS, Seong SC, Lee S, Lee MC. Anterior cruciate ligament reconstruction : quadriceps versus patellar autograft. Clin Orthop Relat Res. 2008;466(1):198-204.

References 21. Haner M, Bierke S, Petersen W. Anterior Cruciate Ligament Revision Surgery: Ipsilateral Quadriceps Versus Contralateral Semitendinosus-Gracilis Autografts. Arthroscopy. 2016;32(11):2308-2317. 22. Häner M, Bierke S, Petersen W. Anterior Cruciate Ligament Revision Surgery: Ipsilateral Quadriceps Versus Contralateral Semitendinosus-Gracilis Autografts. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2016;32(11):2308-2317. 23. Heffron WM, Hunnicutt JL, Xerogeanes JW, Woolf SK, Slone HS. Systematic Review of Publications Regarding Quadriceps Tendon Autograft Use in Anterior Cruciate Ligament Reconstruction. Arthroscopy, Sports Medicine, and Rehabilitation. 2019;1(1):e93-e99. 24. Hunnicutt JL, Gregory CM, McLeod MM, Woolf SK, Chapin RW, Slone HS. Quadriceps Recovery After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Versus Patellar Tendon Autografts. Orthop J Sports Med. 2019;7(4):2325967119839786. 25. Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001;29(5):600- 613. 26. Irrgang JJ, Anderson AF, Boland AL, et al. Responsiveness of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med. 2006;34(10):1567-1573. 27. Knezevic OM, Mirkov DM, Kadija M, Milovanovic D, Jaric S. Evaluation of isokinetic and isometric strength measures for monitoring muscle function recovery after anterior cruciate ligament reconstruction. J Strength Cond Res. 2014;28(6):1722-1731. 28. Lee JK, Lee S, Lee MC. Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction: Bone-Quadriceps Tendon Graft Versus Double-Bundle Hamstring Tendon Graft. Am J Sports Med. 2016;44(9):2323-2329. 29. Lee S, Seong SC, Jo CH, Han HS, An JH, Lee MC. Anterior cruciate ligament reconstruction with use of autologous quadriceps tendon graft. J Bone Joint Surg Am. 2007;89 Suppl 3:116-126. 30. Legnani C, Zini S, Borgo E, Ventura A. Can graft choice affect return to sport following revision anterior cruciate ligament reconstruction surgery? Arch Orthop Trauma Surg. 2016;136(4):527-531. 31. Lepley LK, Palmieri-Smith RM. Quadriceps Strength, Muscle Activation Failure, and Patient-Reported Function at the Time of Return to Activity in Patients Following Anterior Cruciate Ligament Reconstruction: A Cross-sectional Study. J Orthop Sports Phys Ther. 2015;45(12):1017-1025. 32. Lind M, F. Menhert, and A. B. Pedersen. Incidence and Outcome After Revision Anterior Cruciate Ligament Reconstruction: Results From the Danish Registry for Knee Ligament Reconstructions. The American Journal of Sports Medicine. 2012;40(7):1551-1557. 33. Lind M, Menhert F, Pedersen AB. Incidence and Outcome After Revision Anterior Cruciate Ligament Reconstruction: Results From the Danish Registry for Knee Ligament Reconstructions. The American Journal of Sports Medicine. 2012;40(7):1551-1557. 34. Lind M, Menhert F, Pedersen AB. Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions. Am J Sports Med. 2012;40(7):1551-1557. 35. Maletis GB, Chen J, Inacio MCS, Funahashi TT. Age-Related Risk Factors for Revision Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine. 2015;44(2):331-336. 36. Mars Group. Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Am J Sports Med. 2014;42(10):2301-2310. 37. Mars Group. Meniscal and Articular Cartilage Predictors of Clinical Outcome After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2016;44(7):1671-1679. 38. Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R. Revision anterior cruciate ligament reconstruction: an update. Arch Orthop Trauma Surg. 2012;132(9):1299-1313.