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Purpose <p>The optimal autograft for restoring knee strength and expediting return-to-sport following anterior cruciate ligament reconstruction (ACLR) remains debated. This systematic review and meta-analysis compared isokinetic strength and patient-reported outcomes after ACLR using quadriceps tendon (QT), hamstring tendon (HT), or bone–patellar tendon–bone (BTB) autografts to determine graft-specific recovery patterns.</p> Methods <p>PubMed, Cochrane Library, EMBASE, and Google Scholar were systematically searched for comparative studies evaluating isokinetic strength following primary ACLR using QT, HT, or BTB autografts. Non-English, unavailable full-text, animal/cadaveric, and physeal-sparing studies were excluded. MINORS and Detsky evaluated bias risk. Key findings were quantified, and subgroup meta-analyses were performed on limb symmetry index (LSI) values (significance: <i>p</i> &lt; 0.05).</p> Results <p>Seventeen studies (1,705 patients: QT = 765, HT = 725, BTB = 215) with follow-ups through 48 months were included. Due to data heterogeneity, four to six studies qualified for each meta-analysis. Among 13 QT vs. HT studies, QT grafts demonstrated weaker extensor strength in nine (56.3%) and greater flexor strength in six (37.5%). No differences were reported in extensor or flexor strength in four (25.0%) and seven (43.8%) studies, respectively. For QT vs. BTB, two studies (12.5%) showed similar extensor strength, whereas two reported conflicting results. QT had greater flexor strength in one (6.3%) and similar strength in three (18.8%) studies. Postoperative pain was comparable between QT and HT.</p> Conclusions <p>QT autografts resulted in stronger flexion and weaker extension than HT autografts after ACLR. Tailored rehabilitation targeting graft-specific deficits may accelerate recovery. Further research is required to clarify outcomes between QT and BTB autografts.</p> <p><i>Level of evidence</i>: IV.</p>

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Quadriceps Tendon Graft Leads to Stronger Flexion and Weaker Extension of the Knee Than Hamstring Graft Post-ACLR: Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年9月15日

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  • Brandon A. Young,
  • James C. Dawahare,
  • Edward Lee Major III,
  • Eva L. Morrison,
  • Cailan L. Feingold,
  • Eric H. Lin,
  • Joseph N. Liu,
  • Austin V. Stone

摘要

Purpose

The optimal autograft for restoring knee strength and expediting return-to-sport following anterior cruciate ligament reconstruction (ACLR) remains debated. This systematic review and meta-analysis compared isokinetic strength and patient-reported outcomes after ACLR using quadriceps tendon (QT), hamstring tendon (HT), or bone–patellar tendon–bone (BTB) autografts to determine graft-specific recovery patterns.

Methods

PubMed, Cochrane Library, EMBASE, and Google Scholar were systematically searched for comparative studies evaluating isokinetic strength following primary ACLR using QT, HT, or BTB autografts. Non-English, unavailable full-text, animal/cadaveric, and physeal-sparing studies were excluded. MINORS and Detsky evaluated bias risk. Key findings were quantified, and subgroup meta-analyses were performed on limb symmetry index (LSI) values (significance: p < 0.05).

Results

Seventeen studies (1,705 patients: QT = 765, HT = 725, BTB = 215) with follow-ups through 48 months were included. Due to data heterogeneity, four to six studies qualified for each meta-analysis. Among 13 QT vs. HT studies, QT grafts demonstrated weaker extensor strength in nine (56.3%) and greater flexor strength in six (37.5%). No differences were reported in extensor or flexor strength in four (25.0%) and seven (43.8%) studies, respectively. For QT vs. BTB, two studies (12.5%) showed similar extensor strength, whereas two reported conflicting results. QT had greater flexor strength in one (6.3%) and similar strength in three (18.8%) studies. Postoperative pain was comparable between QT and HT.

Conclusions

QT autografts resulted in stronger flexion and weaker extension than HT autografts after ACLR. Tailored rehabilitation targeting graft-specific deficits may accelerate recovery. Further research is required to clarify outcomes between QT and BTB autografts.

Level of evidence: IV.