Quadriceps tendon autograft is not inferior to bone‐patellar tendon‐bone or hamstring autograft in anterior cruciate ligament reconstruction in terms of subjective patient‐reported outcomes: Two‐year results of a multicenter randomised controlled study

PURPOSE: To evaluate the effectiveness of quadriceps tendon (QT) compared to bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts in anterior cruciate ligament reconstruction (ACLR) regarding patient-reported outcomes 2 years postoperatively. METHODS: Patients undergoing primary isolated ACLR were stratified and randomised to receive a QT, BPTB or HT autograft. The primary outcome was the International Knee Documentation Committee (IKDC) subjective score analysed to assess non-inferiority at 2-year follow-up. Secondary outcomes included Knee Injury and Osteoarthritis Outcome Score, Anterior Cruciate Ligament Quality of Life, Lysholm, Tegner, pain and satisfaction scores, IKDC physical examination score, limb symmetry indices, radiographic osteoarthritis and adverse events including failure. RESULTS: One hundred and thirty-six patients were analysed at 2-year follow-up (50 QT, 42 BPTB, 44 HT); 68%, 62% and 64% were male, with mean ages of 26.4, 25.9 and 25.8 years, respectively. The lower limit of the 95% confidence interval (CI) for the IKDC subjective score for the QT group (95% CI 85.4-91.5) fell within the prespecified noninferiority margin (-10). No statistical between-group differences were found for mean IKDC subjective scores (QT, 88.4 ± 8.6; BPTB, 85.5 ± 12.9; HT, 89.2 ± 12.1). All groups showed significant improvement in patient-reported outcomes over time (p < 0.001), with no significant between-group differences. The HT group demonstrated superior quadriceps strength and triple hop performance at 6 months (all p ≤ 0.035), which resolved by 1 year. Four clinical failures occurred in the QT group (8.0%), five in the BPTB group (11.9%) and two in the HT group (4.6%) (n.s.). CONCLUSION: QT autograft is non-inferior to BPTB or HT autograft in isolated ACLR in terms of patient-reported outcomes as measured with the IKDC subjective score two years postoperatively. QT autograft represents a viable option for ACLR. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03073083. LEVEL OF EVIDENCE: Level I.