What Are the Stability, Return-to-sport, and Retear Outcomes of QTPB Allografts in Revision ACL Reconstruction?

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

A retrospective study of 38 cases without controls, including staged procedures and associated meniscal/cartilage surgery, but no anterolateral augmentation. It cannot establish superiority over other grafts or long-term rerupture rates.

KOOS, IKDC, Lysholm and Tegner scores improved significantly at 2 years; 35/38 patients (92.1%) returned to sport.

Participants and Methods

38 patients; mean age, 37.2 ± 12.5 years; mean follow-up, 33.5 ± 19.5 months. There were 33 men and 5 women; 2 cases underwent staged rereconstruction. A retrospective case series with at least 2-year follow-up evaluated clinical scores, KT-2000 arthrometer measurements, return to sport and complications. Second-look arthroscopy assessed graft status in 16 cases. The study procedures used non-gamma-irradiated fresh-frozen allografts.

The order in which you read the painting.

Actual QTPB allograft shape and postoperative AP and lateral images. These surgical images show graft composition, tunnel position and fixation. A revision case series of 38 patients assessed return to sport and stability. Whether the 92.1% return rate means full return to the previous competitive level depends on its definition. With no controls and mixed staged/meniscal procedures, it cannot directly rank this graft against others.

Main Findings

KOOS, IKDC, Lysholm and Tegner scores improved significantly at 2 years; 35/38 patients (92.1%) returned to sport. Side-to-side arthrometer difference decreased from 4.5 ± 2.3 mm to 2.6 ± 1.5 mm (P < 0.001). Graft synovialization was observed in 13 of 16 patients undergoing arthroscopy (81.3%). 4 reruptures (10.5%) occurred at a mean of 18 months.

The point of reading on surgery

The study reports outcomes of QTPB allografts in revision ACL reconstruction, where prior autograft use and tunnel enlargement complicate graft selection. Direct comparative studies are needed because tunnel conditions and concomitant procedures differ.

Limitations

A retrospective study of 38 cases without controls, including staged procedures and associated meniscal/cartilage surgery, but no anterolateral augmentation. It cannot establish superiority over other grafts or long-term rerupture rates.

Let's put it briefly.

What did this study confirm?

KOOS, IKDC, Lysholm and Tegner scores improved significantly at 2 years; 35/38 patients (92.1%) returned to sport.

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

Keywords

Anterior cruciate ligament
Anterior cruciate ligament reconstruction
Quadriceps muscle
Anterior Cruciate Ligament Reconstruction
Anterior Cruciate Ligament Injuries
Bone-Patellar Tendon-Bone Grafting
Retrospective Studies
Young Adult

Abstract · Original text

Do Weon Lee, Sanguk Lee, Du Hyun Ro, Hyuk-Soo Han. Satisfactory Clinical Outcomes of Revision Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Allograft. Clinics in orthopedic surgery. 2025;17(1):91-99. doi:10.4055/cios23409.

BACKGROUD

Allografts are preferred in certain cases of revision anterior cruciate ligament reconstructions to avoid additional graft harvesting and to fill in enlarged tunnels. The clinical outcomes of quadriceps tendon-patellar bone allograft in revision anterior cruciate ligament reconstruction are not well-known. This study was performed to evaluate the clinical outcomes of revision anterior cruciate ligament reconstructions using quadriceps tendon-patellar bone allografts.

METHODS

Patients who underwent revision anterior cruciate ligament reconstructions with quadriceps tendon-patellar bone allografts with a minimum follow-up of 2 years were retrospectively reviewed. Their mean follow-up length was 33.5 ± 19.5 months. Outcomes including clinical scores (Lysholm, International Knee Documentation Committee [IKDC], Tegner scale, and Knee injury and Osteoarthritis Outcome Score [KOOS]), knee stability (physical examinations and knee arthrometer), return to sports, and any associated complications were assessed. Degrees of graft synovialization were also evaluated using arthroscopy.

RESULTS

A total of 38 patients were reviewed and their age at the time of surgery and follow-up length were 37.2 ± 12.5 years (range, 17-66 years) and 2.8 ± 1.6 years, respectively. All clinical scores including KOOS, IKDC, Lysholm, and Tegner scale significantly improved at 2 years after surgery and 92.1% of the patients returned to sports. The mean preoperative side-to-side difference in knee arthrometer decreased from 4.5 ± 2.3 mm before surgery to 2.6 ± 1.5 mm after surgery (p < 0.001). Graft synovialization was observed in 13 of 16 patients (81.3%) who underwent second-look arthroscopy. Complication rate was 10.5% (n = 4). All complications were graft re-rupture and occurred at an average of 18 months after revision surgery.

CONCLUSIONS

Quadriceps tendon-patellar bone allograft showed satisfactory clinical outcomes in revision anterior cruciate ligament reconstruction and thus could be a good alternative when autograft harvesting is not optimal.

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The original paper.

Satisfactory Clinical Outcomes of Revision Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon-Patellar Bone Allograft

Do Weon Lee, Sanguk Lee, Du Hyun Ro, Hyuk-Soo Han
Clinics in Orthopedic Surgery · 2025

DOI · 10.4055/cios23409 PubMed Based data

The first one examined.