Anterior Cruciate Ligament Reconstruction With a Quadriceps Tendon Autograft in Female Patients Shows Equivalent Graft Failure But Lower Activity Scores and Slower Quadriceps Strength Recovery Compared With Male Patients: A Systematic Review and Meta-analysis

Background: The use of a quadriceps tendon (QT) autograft has gained popularity in recent years, and it has been called the “graft of the future.” However, there is limited evidence of its sex-specific outcomes in female patients. Purpose: To assess the outcomes of anterior cruciate ligament reconstruction (ACLR) with a QT autograft specifically in female patients and to elucidate any differences in sex-specific outcomes compared with male patients. Study Design: Systematic review; Level of evidence, 2. Methods: This systematic review was conducted in accordance with PRISMA guidelines using 4 online databases for a review of the literature. Studies using a QT autograft for ACLR but not reporting female-specific outcomes were excluded. Outcomes assessed included patient-reported outcomes, objective functional outcomes, and complications. A meta-analysis was performed in which data allowed for a comparison of outcomes with male patients. Results: There were 9 studies included in this review, with a total of 714 female knees (mean age, 23.0 years) that underwent ACLR with a QT autograft. No difference was observed in the pooled graft failure rate between male and female patients at ≥24 months (8.8% vs 7.4%, respectively; P = .50). Female patients had lower Tegner scores at 24 months ( P = .0007) and a lower quadriceps strength limb symmetry index at 6 months ( P < .0001). No significant difference was seen in the side-to-side difference in instrumented laxity measurements at 6 months ( P = .44) or in Lysholm scores at 24 months ( P = .52). The mean extension loss in female patients was 0.07° (range, –0.22° to 0.58°) at 24 months. The return-to-sport rate in female patients ranged from 71.4% to 82.7%. Conclusion: Evidence from currently available literature suggests that there is no difference in graft failure rates between the sexes after ACLR with a QT autograft. Additionally, female patients have lower activity scores and slower quadriceps recovery compared with male patients.