Quadriceps tendon-bone vs all soft-tissue autografts for primary anterior cruciate ligament reconstruction: a systematic review and meta-analysis of 7,748 patients.

Purpose: The purpose of this systematic review and meta-analysis was to synthesise available evidence on functional outcomes, knee stability, and complications between quadriceps tendon with patellar bone block (B-QT) and quadriceps soft-tissue (S-QT) autografts for primary anterior cruciate ligament reconstructions (ACLR). Methods: A systematic search (PROSPERO ID: CRD42023472220) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was performed on PubMed/MEDLINE, EMBASE, and WoS. The data concerning functional outcomes, knee stability, and complications were analysed. Results: There were 5,898 B-QT patients (67.5% male) and 1,849 S-QT patients (51.5% male) included, with a mean age of 27.4 ± 9.3 and 24.7 ± 9.2 years and mean follow-up of 28.9 months (5.3-123.6 months) and 25.3 months (6.0-69.9 months), respectively. In a meta-analysis, the B-QT had higher KOOS subscales scores: activity-of-daily-living 95.98 (95% CI: 94.09-97.88) vs 93.88 (95% CI: 93.66-94.11), P = 0.028; pain 91.99 (95% CI: 89.48-94.49) vs 88.51 (95% CI: 88.21-88.81), P = 0.005; sports & recreation 84.26 (95% CI: 79.20-89.31) vs 79.21 (95% CI: 78.69-79.73), P = 0.041; symptoms 87.82 (95% CI: 84.75-90.90) vs 81.26 (95% CI: 80.71-81.82), P < 0.001; quality-of-life 78.28 (95% CI: 73.68-82.89) vs 65.37 (95% CI: 60.59-70.15), P < 0.001; and a higher Marx score: 11.90 (95% CI: 10.92-12.87) vs 9.65 (95% CI: 8.21-11.09), P = 0.006. B-QT had higher side-to-side difference in anteroposterior tibial translation: 1.55 mm (95% CI: 1.33-1.77) vs 1.15 mm (95% CI: 0.85-1.33 mm), P = 0.026. Conclusion: A QT autograft, with or without a bone block, provides satisfactory functional outcomes, knee stability, and few complications in primary ACLR. B-QT may result in higher patient-reported outcomes, while S-QT may potentially result in slightly improved knee stability.