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Raj S, Ridha A, Searle HKC, Khatri C, Ahmed I, Metcalfe A, Smith N. Quadriceps tendon versus hamstring tendon graft for primary anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomised trials. Knee 2024; 49:226-240. [PMID: 39043018 DOI: 10.1016/j.knee.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/13/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) is most commonly performed with hamstring tendon (HT) or bone-patellar tendon-bone (BTB) autografts, although the quadriceps tendon (QT) autograft has recently increased in popularity. This systematic review and meta-analysis review compares QT and HT autografts for primary ACLR with a sole focus on randomised controlled trials (RCTs). METHODS A prospective protocol was registered on PROSPERO (CRD42023427339). The search included MEDLINE, Embase and Web of Science until February 2024. Only comparative RCTs were included. The primary outcome was the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score. Secondary outcomes included: other validated patient-reported outcome measures (PROMs), objective strength scores, complications, and return to sport and work. RESULTS From 2,609 articles identified, seven were included (n = 474 patients). This meta-analysis did not identify a significant difference in post-operative IKDC scores (5 articles; p = 0.73), Lysholm scores (3 studies; p = 0.80) or Tegner activity scales (2 studies; p = 0.98). There were no differences in graft failure rates (4 studies; p = 0.92) or in overall adverse events (4 studies; p = 0.83) at 24 months post-ACLR as per meta-analysis. Donor site morbidity scores were significantly lower in the QT group (MD -4.67, 95% CI -9.29 to -0.05; 2 studies, 211 patients; p = 0.05, I2 = 34%). CONCLUSION There were no differences between QT and HT in PROMs, graft failure rates or overall complications based on low- to moderate-quality evidence. There may possibly be lower donor site morbidity with the QT autograft, however, the evidence is not sufficient to draw definitive conclusions.
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Affiliation(s)
- Siddarth Raj
- Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, United Kingdom; Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, Coventry, United Kingdom.
| | - Ali Ridha
- Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, United Kingdom; Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, Coventry, United Kingdom
| | - Henry K C Searle
- Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, United Kingdom; Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, Coventry, United Kingdom
| | - Chetan Khatri
- Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, United Kingdom; Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, Coventry, United Kingdom
| | - Imran Ahmed
- Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, United Kingdom; Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, Coventry, United Kingdom
| | - Andrew Metcalfe
- Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, United Kingdom; Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, Coventry, United Kingdom
| | - Nicholas Smith
- Department of Trauma & Orthopaedic Surgery, University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, United Kingdom; Warwick Clinical Trials Unit, Clinical Sciences Research Laboratories, Coventry, United Kingdom
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McAleese T, Murgier J, Cavaignac E, Devitt BM. A review of Marcel Lemaire's original work on lateral extra-articular tenodesis. J ISAKOS 2024; 9:431-437. [PMID: 38403195 DOI: 10.1016/j.jisako.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
This classic discusses Marcel Lemaire's original publications in the context of modern surgical practice, including a description of his original lateral extra-articular tenodesis. Previously published in French, these translations shed light on his revelations regarding the anterior cruciate ligament's role in knee stability and his detailed insights into the ressaut rotatoire or the pivot shift phenomenon. We track the evolution of Lemaire's procedure since the publication of his original technique in 1967 which used a nylon cord superficial to the lateral collateral ligament followed by cast immobilisation for one month. We report his patient outcomes as he refines his methods through experiential learning. Lemaire's fundamental concepts in relation to anterior cruciate ligament deficiency remain relevant in contemporary clinical practice. Furthermore, the "modified Lemaire technique" has emerged as one of the preferred methods for lateral extra-articular tenodesis. We hope that disseminating his thoughts to a wider audience will help enlighten the ongoing debate regarding the management of rotatory instability. LEVEL OF EVIDENCE: V - Expert Opinion.
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Affiliation(s)
- Timothy McAleese
- RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland; UPMC Sports Surgery Clinic, Santry Demesne, Dublin, D09 VY9H, Ireland.
| | - Jérôme Murgier
- Department of Knee Surgery, Clinique Aguiléra, Biarritz, France
| | - Etienne Cavaignac
- Department of Trauma and Orthopaedics, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Brian M Devitt
- UPMC Sports Surgery Clinic, Santry Demesne, Dublin, D09 VY9H, Ireland; Department of Orthopaedics and Surgical Biomechanics, Dublin City University, D09 V209, Ireland
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