Background: Quadriceps tendon autografts are increasingly used for anterior cruciate ligament reconstruction (ACLR), harvested either with a patellar bone block (quadriceps tendon bone block QTBB) or as an all–soft tissue graft (quadriceps tendon soft tissue QTST). However, comparative data on outcomes remain limited and heterogeneous. Hypothesis: It was hypothesized that there would be no significant differences in patient-reported outcomes, objective stability, return to sports, or complication rates between QTBB and QTST grafts used for primary ACLR. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review of 4 databases (PubMed, Embase, Scopus, and SportDISCUS) was conducted through November 2024. Studies reporting outcomes after primary ACLR using QTBB or QTST autografts were included (Levels 1-4 evidence). Random-effects meta-analyses pooled outcomes for each graft; meta-regression compared grafts while adjusting for follow-up duration and publication year. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: A total of 44 studies (n = 2083; QTBB = 1104; QTST = 979) met the inclusion criteria with a mean follow-up of 29 months. International Knee Documentation Committee scores averaged 79.7 (95% CI, 74.8-84.6) for QTBB and 85.4 (95% CI, 80.9-89.8) for QTST autografts (β = 5.2; P = .11). There were no significant between-group differences in Lysholm, Tegner, or Knee injury and Osteoarthritis Outcome Score subscale scores. Instrumented laxity (KT-1000/2000) was higher for QTBB (1.75 mm 1.30-2.21) versus QTST grafts (0.50 mm 0.35-0.65) (β = −1.25 mm; P = 0.087), although this difference was not statistically significant and QTST results were driven by a single high-volume cohort. No significant differences were found in Lachman, pivot-shift, or anterior drawer grades. Return to sports (RTS) rates were 82% for QTBB and 81% for QTST grafts ( P = .82). Graft failure (both 6%), anterior knee pain (8% vs 7%), and infection (~1%) rates were comparable (all P > .70). Heterogeneity was high for patient-reported outcome measures ( I 2 >75%) but low for complications. Most studies had a moderate risk of bias, and the certainty of evidence was graded as very low across outcomes due to inconsistency, imprecision, and the observational nature of included studies. Conclusion: This systematic review and meta-analysis found no clinically meaningful differences in short-term patient-reported outcomes, graft integrity, RTS rates, or complications between QTBB and QTST grafts in primary ACLR.
Therien et al. (Sun,) studied this question.