Quadriceps Autograft Effective for Arthroscopic ACL Reconstruction in Patients ≥50

Overview

This study evaluated arthroscopic ACL reconstruction using quadriceps tendon (QT) autograft in patients aged 50 and older, demonstrating satisfactory patient-reported outcomes without graft failure or quadriceps tendon rupture. Patients were able to return to pre-injury sports preferences and activity levels at a minimum 2-year follow-up.

Background

ACL injuries are increasingly common in middle-aged patients engaged in pivoting sports. Historically, surgical reconstruction was avoided in older patients due to concerns about complications and osteoarthritis progression. Conservative treatment often leads to residual instability in active older patients, prompting increased use of ACL reconstruction. While bone-patellar tendon-bone and hamstring tendon autografts have been commonly used, quadriceps tendon autograft is gaining popularity due to lower donor site morbidity and reduced failure rates. However, data on QT autograft use in patients over 50 were previously lacking.

Data Highlights

The study included patients aged 50 years and above undergoing primary arthroscopic ACL reconstruction with QT autograft and a minimum 2-year follow-up. Pre-injury patient-reported scores were used as baseline. Outcomes assessed at 2 years included Lysholm knee score, Tegner activity level, visual analogue scale (VAS) for pain, graft failure, quadriceps tendon rupture, and sports preference. Surgical techniques involved minimally invasive QT harvesting with or without bone block, and standardized rehabilitation protocols were applied.

Key Findings

• Arthroscopic ACL reconstruction with QT autograft in patients aged 50+ resulted in satisfactory patient-reported outcomes at 2 years.
• No cases of graft failure or quadriceps tendon rupture were observed during follow-up.
• Patients were able to return to their pre-injury sports preferences and activity levels.
• QT autograft harvesting showed lower donor site morbidity compared to bone-patellar tendon-bone and hamstring tendon grafts.
• Use of QT autograft avoided complications associated with other graft types such as anterior knee pain, sensory deficits, and medial knee instability.

Clinical Implications

QT autograft is a safe and effective graft choice for ACL reconstruction in active patients aged 50 and older, providing good functional outcomes without increased risk of graft failure or quadriceps rupture. Surgeons may consider QT autograft to minimize donor site morbidity and facilitate return to pre-injury activity levels in this population.

Conclusion

Arthroscopic ACL reconstruction using quadriceps tendon autograft in patients aged 50 and above yields favorable outcomes with low complication rates, supporting its use as an effective graft option in older active individuals.

References

1. Fink et al. -- Minimally invasive QT harvesting technique
2. Various studies (2010-2020) -- Outcomes of ACL reconstruction in older patients