Can a Partial-thickness QTPB Autograft and Rectangular Tunnel Reduce Early Donor-site Morbidity Compared with a Round Tunnel in ACL Reconstruction?

Stability and clinical scores improved in both groups, with no significant postoperative difference between groups.

Participants and Methods

78 patients: 40 with rectangular tunnels and 38 with round tunnels. Minimum follow-up was 1 year after surgery. A retrospective comparison of primary ACL reconstructions by 3 specialists assessed rectangular versus round femoral tunnels for stability, clinical scores, quadriceps strength, complications, ROM and graft cross-sectional area.

The order in which you read the painting.

The arthroscopic images show a rectangular tunnel and QTPB graft passage. This short-term comparison included 40 rectangular and 38 round tunnels. A partial-thickness graft could be used in the rectangular group, but similar short-term results with smaller area do not establish equal long-term rerupture risk. Consider differences among 3 surgeons and selection bias.

Main Findings

Both groups improved in stability and clinical scores, with no significant postoperative between-group difference. At 6 months, extension strength deficits at 60°/s were 41.7% with rectangular and 48.9% with round tunnels (P = 0.032). Partial-thickness graft area was about 60% of full-thickness graft area.

The point of reading on surgery

This surgical-technique study considers tunnel shape together with graft-harvest thickness. It suggests possible early quadriceps recovery, but does not show that reducing graft cross-sectional area is safe in the long term.

Limitations

This retrospective short-term comparison involved one surgeon using rectangular tunnels and two other surgeons using round tunnels, with different harvested graft thicknesses, making the technique’s effect difficult to isolate. A lack of short-term significant difference does not establish equivalent long-term rerupture risk. Online publication was in 2023 and issue publication in 2024.

Let's put it briefly.

What did this study confirm?

Stability and clinical scores improved in both groups, with no significant postoperative difference between groups.

Can it be applied directly to individual patients' treatment decisions?

This is a retrospective, short-term comparison. One surgeon selected rectangular tunnels and two others selected round tunnels, with different harvested graft thicknesses, making the technique’s effect difficult to isolate. Lack of a short-term significant difference does not establish equivalent long-term rerupture risk.

Keywords

Anterior cruciate ligament
Anterior cruciate ligament reconstruction
Quadriceps muscle
Anterior Cruciate Ligament Reconstruction
Anterior Cruciate Ligament Injuries
Autografts
Retrospective Studies
Knee Joint

Abstract · Original text

Do Weon Lee, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han. Rectangular-Tunnel Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Autograft Can Reduce Early Donor Site Morbidity While Maintaining Comparable Short-term Clinical Outcomes. Clinics in orthopedic surgery. 2024;16(1):49-56. doi:10.4055/cios21264.

BACKGROUND

Rectangular tunnel and graft have been recently designed to closely resemble the native anatomy in anterior cruciate ligament reconstruction (ACLR). This study was performed to compare the short-term clinical outcomes between rectangular and round femoral tunnels in ACLR using quadriceps tendon-patellar bone (QTPB) autografts.

METHODS

A total of 78 patients who underwent primary ACLR with QTPB autografts performed by three senior surgeons and had at least 1 year of postoperative follow-up were retrospectively reviewed. Patients who underwent rectangular tunnel ACLR (n = 40) were compared to those treated with the conventional round tunnel ACLR (n = 38). Outcomes including knee stability, clinical scores, quadriceps strength, associated complications, postoperative knee range of motion, and cross-sectional area of the graft were assessed.

RESULTS

Significant improvements in knee stability and clinical scores were observed after surgery in both groups (all p < 0.001). The postoperative measurements of knee stability and clinical scores were not significantly different between the two groups. Knee extension strength deficit at 60°/sec was significantly less in the rectangular tunnel group than in the round tunnel group at postoperative 6 months (41.7% vs. 48.9%, p = 0.032). The cross-sectional area of the partial-thickness QTPB graft was approximately 60% of the full-thickness QTPB graft.

CONCLUSIONS

In the short-term, rectangular tunnel ACLR was comparable to round tunnel ACLR with QTPB autograft despite the smaller cross-sectional area. Additionally, the rectangular tunnel ACLR allowed partial-thickness grafting technique, which could subsequently reduce early donor site morbidity.

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The original paper.

Rectangular-Tunnel Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Autograft Can Reduce Early Donor Site Morbidity While Maintaining Comparable Short-term Clinical Outcomes

Do Weon Lee, Du Hyun Ro, Myung Chul Lee, Hyuk-Soo Han
Clinics in Orthopedic Surgery · 2024

DOI · 10.4055/cios21264 PubMed Based data

The first one examined.