Comparative Study of Anterior Cruciate Ligament Reconstruction (Quadriceps Versus Hamstring Tendon)
Condition: Acute Injury of Anterior Cruciate Ligament
MeSH terms: Anterior Cruciate Ligament Injuries
Study type: Interventional

Summary: 
      The purpose of this randomized study is to compare clinical and functional outcomes of both
      surgery techniques for anterior cruciate ligament reconstruction (using quadriceps tendon
      versus hamstring tendon) after reconstruction in athletes.
    

Detailed description: 
      Background: The anterior cruciate ligament (ACL) is the most commonly injured ligament of the
      knee. An ACL-deficient knee can lead to recurrent instability, meniscus tears, and
      osteoarthritis. Patients treated with an ACL reconstruction (ACLR) have long term success
      rates of 80 percent to 95 percent. Graft selection may influence outcomes following ACLR.
      Despite the popularity of the procedure, the preferred graft remains controversial. In the
      past, bone-patellar tendon-bone grafts have been considered the gold-standard surgical
      option. However, concerns regarding donor-site morbidity have led to a shift in practice by
      many surgeons to use quadruple hamstring tendons (HT).Several studies have shown a deficit in
      the quadriceps and the hamstrings strength after using HT as a graft for ACLR . Recently,
      there has been an increased interest in the quadriceps tendon as graft option for ACL
      reconstruction. The benefits of quadriceps tendon autograph include advantageous
      biomechanical properties, preservation of hamstring anatomy and function, as well as a
      reduced incidence of donor-site morbidity. To our knowledge there is no randomized controlled
      trial in the literature comparing QT and HTas autografts for ACLR.

      Objective: The purpose of this randomized prospective study is to compare clinical and
      functional outcomes after using the QT and HT tendons for ACL reconstruction in athletes.

      Methods: 55 athletes patients will be recruited from Martín Gómez Clinic from Granada (Spain)
      and Nutuality of footballers from Andalusian (Spain). Patients will be randomized in two
      groups: quadriceps tendon versus hamstring tendon. Clinical and functional outcomes will be
      measured before surgery and three and six months after that. All patients will be operated on
      by the same senior surgeon and both group will received the same postoperative rehabilitation
      protocol. Prior to the surgery the participants or their legal representatives must sign the
      informed consent for participation in this research.

      Discussion: The benefits of ACL reconstruction surgery show enough scientific evidence that
      justifying the emergence of new procedures that improve the outcome of the surgery and the
      reduction of possible comorbidities. The high prevalence of this disease and the therapeutic
      success of ACL reconstruction makes that there is an increase of the number of subjects who
      have received this treatment. However, there is not enough randomized trials that examines
      the different techniques in terms of clinical and functional outcomes or the risk of
      comorbidities.

      Subjects were placed in the upright position with the hip flexed at 90°. To determine the
      height of the chair, the lateral femoral condyle was aligned with the rotational axis of the
      dynamometer. Before each test, the patient was instructed to perform 3 practice repetitions.
      The highest peak torque value for each velocity was determined, compared to the uninjured
      side, and described as percent of knee extensor and flexor muscles strength deficits.
    

Intervention name(s): QUADRICEPS TENDON; HAMSTRING TENDON
Intervention type(s): Procedure; Procedure
Intervention description(s): Once the limb is prepped and draped,it is exsanguinated, and the tourniquet is raised to 250 mm Hg. We will make an arthroscopic examination through an anterolateral viewing portal to corroborate the ACL injury as well as the determination of possible associated lesions. The accessory medial portal is stablished slightly above the joint line (about 2 cm of the medial edge of the patel) that is used as an instrumentation portal. Then,, a high anteromedial portal, is made higher than the previous to see the femoral footprint. Once the associated meniscal or cartilaginous lesions are addressed attention turns to the harvesting of the graft. A 4 cm vertical incision is made starting at the proximal pole of the patella and directed proximally and centered in line with the quadriceps tendon. The subcutaneous tissue is dissected and a 70-80 mm long ,10 mm wide and 7mm depth graft is obtained with the use of a n21 scalpel 2cm of both limbs of the graft are sutured; Once the limb is prepped and draped,it is exsanguinated, and the tourniquet is raised to 250 mm Hg. The procedure begins with an arthroscopic examination through an anterolateral viewing portal to corroborate the ACL injury as well as the determination of possible associated lesions. The accessory medial portal is stablished slightly above the joint line, at about 2 cm of the medial edge of the patellar tendon. This portal is used as an instrumentation portal. A third portal, a high anteromedial portal, is made higher than the previous, this portal will allow visualization of the femoral footprint.
Once the associated meniscal or cartilaginous lesions are addressed attention turns to the harvesting of the graft.
A 4cm oblique incision is made starting 2 cm medial to the tibial tubercle and directed proximally and medially. After dissecting the subcutaneous tissue the Sartorius fascia is incised and both tendons are identified and harvested with the use of a tendon stripper
Other intervention name(s): quadriceps tendon graft; hamstring tendon graft
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION; QUADRICEPS TENDON; HAMSTRING TENDON