Title : Quadriceps tendon versus hamstring tendon autografts in acl reconstruction: A systematic review and meta-analysis
Abstract:
Background: The selection of autograft for Anterior Cruciate Ligament Reconstruction (ACLR) remains a point of significant debate. While Hamstring Tendon (HT) autografts have long been the gold standard for many surgeons, the Quadriceps Tendon (QT) has emerged as a compelling alternative due to its robust cross-sectional area and lower incidence of harvest-site morbidity.
Objective: To systematically evaluate and compare the clinical, functional, and donor-site outcomes of Auadriceps Tendon (QT) versus Hamstring Tendon (HT) autografts in patients undergoing primary ACLR.
Methods: A systematic review and meta-analysis were performed following PRISM guidelines. We searched PubMed, Scopus, and Cochrane libraries for Candomized Controlled Trials (RCTs) and prospective comparative studies published up to 2026. Primary outcomes were graft failure rates and patient-reported outcome measures (PROMs). Secondary outcomes included knee stability (measured via KT-1000 or pivot-shift) and donor-site complications (numbness, weakness, and pain).
Results: Analysis of current data, including the large-scale 2026 multicenter trials, revealed no significant difference in graft failure rates between QT and HT groups. Functional scores, such as the IKDC and Lysholm scales, were comparable across both cohorts. However, the QT group exhibited significantly lower rates of sensory loss over the lateral leg and better preservation of hamstring strength compared to the HT group. Conversely, some studies noted a higher incidence of minor donor-site pain in the QT group when harvested with a bone plug.
Conclusion: Quadriceps tendon autografts provide clinical and stability outcomes equivalent to hamstring tendon autografts. Given the reduced risk of permanent hamstring weakness and sensory disturbances, the QT autograft is a highly effective and versatile option for primary ACL reconstruction.
