Revision anterior cruciate ligament reconstruction using an autogenous quadriceps tendon graft is associated with substantial improvement in patient-reported outcomes.

INTRODUCTION

Revision anterior cruciate ligament reconstruction (rACLR) presents multiple technical challenges, including having to contend with limited graft availability and compromised bone stock. The quadriceps tendon (QT) autograft-often preferred for its large diameter, high collagen content, and reduced donor-site morbidity compared to patellar tendons-has emerged as a promising option due to its biomechanical strength and reduced donor site morbidity.

OBJECTIVE

To evaluate clinical and functional outcomes of rACLR using autologous QT grafts with a bone block, focusing on improvements in knee scores such as the Lysholm Knee Score, eventual return to sport, and complication rates.

METHODS

A total of 50 patients who underwent revision anterior cruciate ligament reconstruction (rACLR) using a quadriceps tendon (QT) autograft with a bone block between 2019 and 2023 were retrospectively analyzed. Patient-reported outcome measures (PROMs) were assessed using the Lysholm score and the International Knee Documentation Committee (IKDC) subjective score preoperatively and at final follow-up. Surgical technique and concomitant procedures were recorded. No objective functional performance tests were evaluated.

RESULTS

The mean age, 31.3 ± 7.8 years; 42 males and 8 females, all patients completed a minimum and fixed follow-up of 24 months; therefore, no variability in follow-up duration was observed (standard deviation -SD- 0), the Lysholm score improved from 54.6 ± 13.4 SD to 89 ± 7.6 SD (p < 0.001), and the International Knee Documentation Committee (IKDC) subjective score from 53.7 ± 14.1 standard deviation (SD) to 85.9 ± 6.7 SD (p < 0.001). Concomitant procedures included lateral extra-articular tenodesis (LET) in 28% and meniscal repairs in 58% of patients. Graft re-rupture after revision ACL reconstruction occurred in 8.3% of patients (all in the non-LET group). When comparing patients with and without concomitant LET, no statistically significant difference in re-rupture rates was observed (p = 0.55). Return to sport was achieved in 81.8% of the cases. There were no cases of arthrofibrosis ((knee stiffness), quadriceps weakness, or donor-site complications.

CONCLUSION

Revision ACLR using autologous QT grafts with bone block provides satisfactory clinical and functional outcomes, with improvements in validated knee scores and a high return-to-sport rate. The low incidence of complications and graft failure reinforces the safety and reliability of this technique in complex revision cases.

LEVEL OF EVIDENCE: V.