Patients With a Quadriceps Tendon Autograft Demonstrate Greater Asymmetry in Landing Kinetics Than Patients With a Bone–Patellar Tendon–Bone Autograft 6 Months After Anterior Cruciate Ligament Reconstruction

Abstract

Background:

Asymmetric landing kinetics 6 months after anterior cruciate ligament reconstruction (ACLR) are associated with higher risk of second anterior cruciate ligament injury. Little is known about landing kinetics after ACLR with an all–soft tissue quadriceps tendon (QT) autograft despite its increasingly common use in young, active patients.

Purpose/Hypothesis:

The purpose of this study was to compare landing kinetics during a bilateral drop vertical jump (DVJ) 6 months after ACLR in participants who had undergone primary ACLR with a QT or bone–patellar tendon–bone (BTB) autograft. The hypothesis was that patients with a QT autograft will experience more asymmetry during a bilateral DVJ than patients with a BTB autograft 6 months after ACLR. In addition, greater impact force asymmetry will be associated with worse patient-reported outcome measures.

Study Design:

Controlled laboratory study.

Methods:

Participants who underwent primary unilateral ACLR with a QT or BTB autograft between May 2022 and December 2023 were prospectively recruited to undergo DVJ assessment and patient-reported outcome measures 6 months after ACLR. DVJ assessment was completed using force-sensing insoles. Peak impact force, average loading rate, and impulse data were collected at 100 Hz.

Results:

Forty-four participants (22 BTB, 22 QT) completed DVJ assessment and International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI) surveys at 6 ± 1 months after ACLR. Graft source groups did not differ by age (P = .884), sex (P = .531), mass (P = .872), height (P = .572), months since surgery (P = .683), or lateral (P = .637) or medial (P = .416) meniscal tear treatment rate. On average, participants with a QT autograft demonstrated 26.2% greater contralateral limb peak impact force (P = .004), 18.4% lower peak impact force limb symmetry index (P = .009), 18.5% lower involved limb impulse (P < .001), and 15.1% lower impulse limb symmetry index (P < .001) when compared with participants with a BTB autograft. Graft source groups did not differ in IKDC score (P = .333) or ACL-RSI score (P = .070). Neither IKDC nor ACL-RSI score was strongly associated with any kinetic variables.

Conclusion/Clinical Relevance:

Participants with a QT autograft exhibit greater asymmetry in landing kinetics when compared with participants with a BTB autograft 6 months after ACLR, and landing kinetics were not associated with IKDC or ACL-RSI score.