Aims

The free latissimus dorsi muscle (LDM) flap represents a workhorse procedure in the field of trauma and plastic surgery. However, only a small number of studies have examined this large group of patients with regard to the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of a free LDM flap.

Aim: To compare the donor site morbidity after anterior cruciate ligament (ACL) reconstruction using ipsilateral and contralateral bone-patellar-tendon (BPT) autograft. Patients and Method: 100 patients underwent ACL- reconstruction with autologous BPT graft between 1997 and 1999. ACL-reconstruction was performed using ipsilateral (n= 52) and contralateral (n= 48) BPT-autograft. The average follow-up was 39,2 months. Donor site morbidity was evaluated by using a questionaire, computerised historical data, KT-2000 measurments, Cincinnati- (CKS) and Tegner-Score. Results: KT-2000 evaluation showed an average side to side difference of 0,6 mm in both groups. There were no significant differences between the two groups concerning CKS or Tegner-Score. In the ipsilateral donor knee, 59,6% of the patients had local tenderness, 69,2% kneeling-pain, 76,9% knee-walking-pain and 75% numbness. In the contralateral donor knee, 58,3% of the patients had local tenderness, 70,8% kneeling-pain, 70,8% knee-walking-pain and 85,4% numbness. In the ACL reconstructed knee 6,3% had local tenderness,6,3% kneeling-pain, 10,4% knee-walking-pain and 64,6% numbness. There was one rupture of the patellar tendon and one patient with chronic patellar tendinitis. Conclusion: The contralateral BPT graft appears to present no advantage over the ipsilateral as all symptoms concerning donor site morbidity are shifted from the injured into the healthy knee and return to activity is not more rapid

Aim: To evaluate activity level and remaining symptoms concerning the donor site morbidity in patients having anterior cruciate ligament reconstruction (ACLreconstruction) with either ipsilateral or contralateral bone-patellar-tendon graft (BPT-graft). Methods: 100 patients aged from 18 to 49 years (mean 34) having an ACL-reconstruction with BPT-graft (with one bone block) from 1997 to 1999 were included in this study. In 52 of them a BPT-graft from the ipsilateral side was used (Group I). In 48 the contralateral BPT was used (Group II). A questionaire, including Cincinnati-, Tegner-activity score and special questions concerning persisting symptoms at the donor site, such as tenderness, numbness, kneeling pain and knee-walking pain, was sent to all patients. Results: The average Cincinnati Scoring was 85,2 in Group I and 86,3 in Group II. There was no statistical significance in Tegner scoring between the two groups. In Group I, 37,5% of the patients refered local tenderness, 59,6% kneeling pain and 82,65% knee-walking pain. According to contralateral leg in Group II, 37,5% of the patients refered local tenderness, 52% kneeling pain and 62,5% knee-walking pain vs. 8,3%, 25% and 25% respectively in the ACL reconstructed knee. Conclusions: This study showed that there are no benefits if the contralateral BPT graft is used, because all symptoms concerning donor site morbidity are shifted from the injured into the healthy knee if the graft is taken from the contralateral side

The study describes a technique of tibial autograft to augment posterior instrumented spinal fusion in a population of paediatric patients with severe idiopathic, neuromuscular or syndromic scoliosis who are at a higher risk of postoperative pseudarthrosis and reports patient outcomes in terms of union rate, donor site morbidity and cost. Patients were identified from a review of waiting list and operating room records between 2007–2014. Surgery was performed by the senior author. Information on patient demographics, underlying diagnosis, age at surgery, revision surgery and length of follow-up was obtained from clinic notes. Parents of children were followed up with a structured telephone questionnaire regarding ambulatory status, post-operative pain, infection, further surgery and general satisfaction. Four hundred and nine patients underwent posterior instrumented spinal fusion, during the study period. Forty-two patients’ fusions were augmented with tibial graft, 40 of whom participated in the study. There were no cases of donor site infection, compartment syndrome, tibial fracture or perioperative mortality. In 85% of cases leg pain had resolved within 6 weeks, and 100% within 6 months of surgery. There were 6 cases of revision spinal surgery, 3 for infection, 2 for sacroiliac screw removal and 1 for sacroiliac screw revision. There were no clinical cases of spinal pseudarthrosis in this series. All parents were satisfied by the clinical outcome of both the tibial and spinal surgeries. Spinal fusion utilising tibial autograft is advocated as a simple, safe and cost-effective method of providing significant structural autograft to support fusion for a population of patients with high risk of junctional pseudarthrosis. With the exception of transient post-operative pain, the procedure was without any serious donor site morbidity. The outcomes of this study were as expected and in keeping with previous reports

Ten adults were studied two to seven years after resection of a fibula for use as a free vascularised bone graft. Six had no symptoms in the donor leg, four had some aching, weakness or paraesthesia and three had definite weakness of the long toe flexors and extensors. All knees and ankles were clinically and radiologically stable, but the distal fibular remnant was osteoporotic in nine patients. Gait analysis of the donor leg and the contralateral normal leg showed definite differences, which could be attributed to weakness of the deep muscles caused by loss of their normal origin and to the change in load transmission through the fibula.

Introduction: The aim of this study was to evaluate the anterior knee symptoms after anterior cruciate ligament reconstruction (ACL) using either pateller tendon (PT) or hamstring tendon (HS) autograft.

Materials and Methods: 45 patients undergoing primary ACL reconstruction were randomized to have a PT (23 patients) or a doubled HS (22 patients). Patients were reviewed after 3, 6, and 9 months. Patients were examined for knee pain and sensory changes in the anterior aspect of the knee, the ability for kneeling and sensitivity of the surgical incision.

Results: At the last follow-up in the PT group 4 patients (17%) had anterior knee pain, knee-walking test was impossible for 4 patients (17%), 3 patients (13%) reported to have surgical incision sensitivity and 4 patients (17%) had numbness in the skin area supplied by the infrapatellar branch of the saphenous nerve. In the HS group, 2 patients (9%) had anterior knee pain, knee-walking test was impossible for 2 patients (9%), 2 patients (9%) reported to have surgical incision sensitivity and 10 patients (45%) had numbness in the skin area supplied by the infrapatellar branch of the saphe-nous nerve. There was a statistical significant difference (p< 0.05) regarding the sensory changes in the anterior aspect of the knee.

Conclusions: Harvesting of the PT or HS autograft for ACL reconstruction is associated with a low rate of anterior knee symptoms. Sensory changes following HS harvesting is significantly higher. However, this does not appear to be of great clinical importance without limitation of activities.

Purpose: The aim of this study was to document donor site problems one year after anterior cruciate ligament (ACL) reconstruction and to compare the differencies between hamstring and patellar tendon autografts.

Materilas and Methods: Sixty-four patients undergoing primary arthroscopically ACL reconstruction were randomized to have a central third bone patellar tendon bone (PT) autograft (30 patients) or a doubled semiten-dinosus/doubled gracilis (HS) autograft (34 patients). The postoperative rehabilitation regimen was identical for both groups. All patients were examined one year postoperatively. Objective parameters evaluated included pre and postoperative IKDC and Lysholm score, side-to-side KT-1000 maximum-manual arthrometer differences. The Shelbourne score was used to evaluate anterior knee symptoms. Loss of sensitivity in the anterior knee region postoperatively as well as scar sensitivity were also recorded.

Results: Three patients (10%) in the PT group had anterior knee symptoms while only one (3%) in the HS group. The mean Shelbourne score was 98 for the HS group and 93 for the PT group but this was not statistically significant. However, 8 pateints (23%) had disturbed sensitivity in the anterior knee region in the HS group, but none in the PT group and this was statistically significant (p< 0.005). Scar sensitivity was present in 3 patients (10%) in the PT group and in one (3%) in the HS group. No differencies were found postoperatively between the groups regarding IKDC, Lysholm score and side-to-side KT-1000 measurements.

Conclusions: Although,notstatisticallysignificantpatients in the PT group had more anterior knee symptoms and scar sensitivity, one year postoperatively. In contrast, harvesting of hamstring tendons produces significantly more sensory nerve complications in the anterior knee region than harvesting the middle third of patellar tendon. Both grafts seem to improve equally patients’ performance.

Hamstring grafts have been associated with reduced strength, donor site pain and muscle strains following Anterior Cruciate Ligament Reconstruction (ACLR). Traditional graft fixation methods required both semitendinosus and gracilis tendons to achieve a graft of sufficient length and diameter, but newer techniques allow for shorter, broad single tendon grafts. This study seeks to compare the outcomes between Single Tendon (ST) and Dual Tendon (DT) ACLR, given there is no prospective randomised controlled trial (RCT) in the literature comparing outcomes between these options. In this ongoing RCT: (ANZ Clinical Trials Registry ACTRN126200000927921) patients were recruited and randomised into either ST or DT groups. All anaesthetic and surgical techniques were uniform aside from graft technique and tibial fixation. 13 patients were excluded at surgery as their ST graft did not achieve a minimum 8mm diameter. 70 patients (34 ST, 36DT) have been assessed at 6 months, using PROMS including IKDC2000, Lysholm and Modified Cincinnati Knee, visual analog scale for pain frequency (VAS-F) and severity (VAS-S), dedicated donor site morbidity score, KT-1000 assessment, and isokinetic strength. Graft diameters were significantly lesser in the ST group compared to the DT group (8.44mm/9.11mm mean difference [MD],-0.67mm; P<0.001). There was a significant and moderate effect in lower donor site morbidity in the ST group compared to the DT group (effect size [ES], 0.649; P = .01). No differences between groups were observed for knee laxity in the ACLR limb (P=0.362) or any of the patient-reported outcome measures (P>0.05). Between-group differences were observed for hamstrings strength LSI favouring the ST group, though these were small-to-moderate and non-significant (ES, 0.351; P = .147). ST (versus DT) harvest results in significantly less donor site morbidity and this is the first prospective RCT to determine this. There were no differences between ST and DT hamstring ACLR were observed in PROMs, knee laxity and hamstring strength. Younger female patients tend to have inadequate single tendon size to produce a graft of sufficient diameter, and alternative techniques should be considered. Further endpoints include radiological analysis, longer term donor site morbidity, revision rates and return to sport and will continue to be presented in the future

Abstract. Purpose. This study aims to compare the clinical and functional outcomes and donor site morbidity of anterior cruciate ligament reconstruction with hamstring tendon autograft and peroneus longus tendon autograft in patients with complete anterior cruciate ligament rupture. Methods. Patients who underwent ACL reconstruction from February 2018 to July 2019 were randomly allocated into two groups (hamstring and peroneus longus). Functional scores (IKDC and Lysholm scores) and pain intensity by visual analogue score were recorded preoperatively, 3, 6months, 1, and 2 years postoperatively. Donor site morbidities were assessed with thigh circumference measurements in hamstring group and ankle scoring with the American foot and ankle score in peroneus longus group. Results. Sixty patients (hamstring n = 30, peroneus n = 30) met the inclusion criteria. The functional scores (IKDC and Lysholm) did not show statistical difference among the two groups at two years follow-up (P- value>0.05). The means values for visual analogue score after two years in the hamstring and Peroneus longus group was 1±0.74 and 1.03± 1.06, respectively. In peroneus longus group, the mean foot and ankle score was 98.63±3.88 (range= 85–100). A significant difference was found in the hamstring group between operated and non-operated thigh circumferences with p- value <0.001. Conclusions. Peroneus longus tendon autograft is an easily accessible tendon for ACL reconstruction and gives comparable functional outcomes as hamstring tendon with no additional donor site morbidity in our study

Aims. We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods. We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results. The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion. Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate correction of alignment and calcaneal malunion. We recommend using local instead of iliac bone graft as it gave comparable results and avoids the possibility of donor site morbidity. Cite this article: Bone Joint J 2019;101-B:596–602

Abstract. Purpose. Since arthroscopic reconstruction of the anterior cruciate ligament (ACL) started, the use of peroneus longus grafts for primary ACL reconstruction (ACLR) was never thought of as there is very scant literature on it. So, our study aims to compare the functional outcome and complications in patients with ACL injury managed by ACLR with peroneus longus tendon (PLT) and hamstring tendons (HT) respectively. Materials and Methods. Patients with 16–50 years of either gender presenting with symptomatic ACL deficiency were admitted for arthroscopic single bundle ACLR and allocated into two groups (PLT and HT) operated and observed. Functional scores (IKDC and Lysholm score), clinical knee evaluation, donor site morbidity (AOFAS score) and thigh circumference were recorded preoperatively and at six months, one year post-operatively. The same post-op rehabilitation protocol was followed in both groups. Results. 194 patients (hamstring n=96, peroneus n=98) met the inclusion criteria. There were no significant differences between the pre-op, six months post-op and one-year postoperative score between the hamstring and peroneus longus groups in the IKDC (p=0.356) and Lysholm knee score (p=0.289). The mean for the AOFAS was 99.05±3.56 and 99.80±0.70 in the PLT and HT group respectively showing no statistical difference, with a significant improvement in thigh muscle wasting among the PLT group at final follow-up (p<0.001). Conclusion. We observed similar knee stability, functional outcome and no obvious donor site morbidity among both groups and recommend that a PL graft may be a safe, effective, and viable option for arthroscopic single bundle ACL reconstruction

Introduction. Significant donor site morbidity (3–61%) has been associated with tri-cortical iliac crest bone graft harvesting and reconstruction of the defect has been shown to reduce it. Chitra-HABG (Chitra-Hydroxyapatite-Bio-active glass ceramic composite) is an indigenously developed ceramic which has been evaluated as a bone graft substitute. Aim. To prospectively validate the hypothesis that iliac crest donor site morbidity is a structural issue and reconstructing the crest reduces its incidence. The study also evaluates the efficacy of Chitra - HABG as a material for reconstructing the crest. Methods. 26 cases of iliac crest reconstruction with Chitra-HABG blocks were prospectively evaluated. Outcome measures were donor site morbidity as assessed clinically and radiological assessment for ceramic incorporation, dissolution, fragmentation and migration. Results. At the end of one year from surgery, 25 patients (96.15%) had no donor site pain. Radiological evaluation showed that ceramic incorporation was complete in 21 cases, partial in three and absent in two. Partial dissolution of ceramic was noticed in three patients and migration in one. Conclusion. The present study validates our hypothesis that the donor site morbidity following tri-cortical iliac crest graft harvesting is probably a structural issue and it can be reduced by reconstruction of the defect. It also highlights the fact that the Chitra-HABG block is an excellent material for reconstruction of the iliac crest defect, as it gets incorporated into the surrounding bone without adverse effects. Significance. Study describes a simple and effective method to decrease iliac crest donor site morbidity. Level of evidence: IV. Study Design. Prospective study. Summary. Prospectively evaluate the efficacy of Chitra-HABG blocks for iliac crest reconstruction

Medial opening wedge high tibial osteotomy (MOWHTO) is the workhorse procedure for correcting varus malalignment of the knee. There have been recent developments in the synthetic options to fill the osteotomy gap. The current gold standard for filling this osteotomy gap is autologous bone graft which is associated with donor site morbidity. We would like to introduce and describe the process of utilizing the novel Osteopore® 3D printed, honeycomb structured, Polycaprolactone and β-Tricalcium Phosphate wedge for filling the gap in MOWHTO. In the advent of additive manufacturing and the quest for more biocompatible materials, the usage of the Osteopore® bone wedge in MOWHTO is a promising technique that may improve the biomechanical stability as well the healing of the osteotomy gap

Introduction. Anterior cruciate ligament (ACL) injuries represent a significant burden of disease to the orthopaedic surgeon and often necessitate surgical reconstruction in the presence of instability. The hamstring graft has traditionally been used to reconstruct the ACL but the quadriceps tendon (QT) graft has gained popularity due to its relatively low donor site morbidity. Methods. This is a single centre comparative retrospective analysis of prospectively collected data of patients who had an ACL reconstruction (either with single tendon quadrupled hamstring graft or soft tissue quadriceps tendon graft). All surgeries were performed by a single surgeon using the All-inside technique. For this study, there were 20 patients in each group. All patients received the same post-operative rehabilitation protocol and were added to the National Ligament Registry to monitor their patient related outcome scores (PROM). Results. The average age of patients in the QT group was 29 years (16 males, 4 females) and in the hamstring group was 28 years (18 males, 2 females). The most common mechanism of injury in both groups was a contact twisting injury. There were no statistical differences between the two patient groups in regards to PROMS and need for further revision surgery as analysed on the National Ligament Registry. Conclusions. The all soft tissue QT graft seems to be equivocal to quadrupled hamstring graft in terms of patient function and recovery graft characteristics. Further research may be needed to elucidate the long-term results of the all soft tissue QT graft given its recent increase in use

Ankle sprains are common injuries. Most of them involve the lateral ligament complex. 20–40%% of these injuries will go onto develop symptomatic chronic lateral instability (CLI) and require surgical intervention. The gold standard surgical treatment remains the Brostom-Gould. There are however certain scenarios where this may be unsuitable, such as in hyperlaxity, poor native tissue or revision surgeries. In these situations, a reconstruction with some form of augmentation or grafting is necessary. The anterior half of peroneus longus (AHPL) has gained in popularity as an autograft due to its favourable tendon properties, ease of harvesting, and low reported morbidity. This technique has been adopted by the senior author in these situations. Our primary aim was to assess patient reported outcomes and satisfaction following this surgery. Our secondary objectives were to assess return to sports, donor site morbidity and to report any surgical complications. We performed a retrospective single surgeon study on all patients who underwent CLI reconstruction using the anterior half of peroneus longus between 2014 and 2021. Data was collected prospectively. The Karlsson foot and ankle scoring chart as well as a simple satisfaction table were used to assess outcomes. Minimum follow up was 1 year. 44 patients met the inclusion criteria. 23 women, 21 men. The average age was 37.0 (+−13.5). 24 were very satisfied with the surgery, 10 were satisfied, 6 were fair and 4 were dissatisfied. The average Karlsson score improved from 65/90 (34–77) to 85/90 (range 45–90). The average return to sport was 5 months. There was 1 non-surgical complication recorded. There was no repeat surgery for a complication, or recurrent instability and no donor-site morbidity was reported. The results of our study demonstrates that the CLIR using AHPL is a reliable, predictable and safe

Bone defects and fractures, caused by injury, trauma or tumour resection require hospital treatment and temporary loss of mobility, representing an important burden for societies and health systems worldwide. Autografts are the gold standard for promoting new bone formation, but these may provide insufficient material and lead to donor site morbidity and pain. We previously showed that Fibrinogen (Fg) scaffolds promote bone regeneration in vivo (1), and that modifying them with 10mM of Magnesium (Mg) ions modulates macrophage response in vitro and in vivo (2). Also, we showed that Extracellular Vesicles (EV) secreted by Dendritic Cells (DC) recruit Mesenchymal Stem/Stromal Cells (MSC)(3). Herein, we aim to functionalize FgMg scaffolds with DC-EV, to promote recruitment and osteogenic differentiation of MSC. Scaffolds were produced by freeze-drying (2). Ethical permission was sought for all studies. Primary human peripheral blood monocyte-derived DC were cultured, their secreted EV were isolated by differential (ultra)-centrifugation and characterised by transmission electron microscopy and nanoparticle tracking analysis (3). Bone marrow MSC were used to determine the impact of EV-functionalized scaffolds through migration assays and their osteogenic differentiation was assessed by Alizarin Red staining. Fg and FgMg scaffolds functionalized with EV were characterized. Fg and FgMg scaffolds functionalized with DC-secreted EV were more efficient at recruiting MSC than scaffolds alone. MSC cultured on FgMg scaffolds showed significantly increased calcium deposits, in comparison with those cultured on Fg scaffolds. Fg scaffold modification by Mg promotes MSC osteogenic differentiation, while their functionalization with DC-secreted EV acts to promote MSC recruitment. This renders the FgMg-EV functionalized scaffolds an attractive material to promote new bone formation. Acknowledgments: Work funded by Orthoregeneration Network (ON Pilot Grant Spine 2021, EVS4Fusion). MCT supported by ERASMUS+ program

Although autografts represent the gold standard for anterior cruciate ligament (ACL) reconstruction, tissue-engineered ACLs provide a prospect to minimize donor site morbidity and limited graft availability. This given study characterizes the ligamentogenesis in embroidered poly(L-lactide-co-ε-caprolactone) (P(LA-CL)) / polylactic acid (PLA) constructs using a dynamic nude mice xenograft model. (P(LA-CL))/PLA scaffolds remained either untreated (co) or were functionalized by gas fluorination (F), collagen foam cross-linked with hexamethylene diisocyanate (HMDI) (coll), or gas fluorination combined with the foam (F+coll). Cell free constructs or those seeded for 1 week with lapine ACL ligamentocytes were implanted into nude mice for 12 weeks. Following explantation, biomechanical properties, cell vitality and content, histopathology of scaffolds (including organs: liver, kidney, spleen), sulphated glycosaminoglycan (sGAG) contents and biomechanical properties were assessed. Implantation of the scaffolds did not negatively affect mice weight development and organs, indicating biocompatibility. All scaffolds maintained their size and shape for the duration of the implantation. A high cell viability was detected in the scaffolds prior to and following implantation. Coll or F+coll scaffolds seeded with cells yielded superior macroscopic properties when compared to the controls. Mild signs of inflammation (foreign-body giant cells, hyperemia) were limited to scaffolds without collagen. Microscopical score values and sGAG content did not differ significantly. Although remaining stable in vivo, elastic modulus, maximum force, tensile strength and strain at Fmax were significantly lower in the in vivo compared to the samples cultured 1 week in vitro, but did not differ between scaffold subtypes, except for a higher maximum force in F+coll compared with F samples (in vivo). Scaffold functionalization with fluorinated collagen foam provides a promising approach for ACL tissue engineering. (shared first authorship). Acknowledgement: The study was supported by DFG grants SCHU1979/9-1 and SCHU1979/14-1

Aims. To evaluate the donor site morbidity and tendon morphology after harvesting whole length, full-thickness peroneus longus tendon (PLT) proximal to the lateral malleolus for ligament reconstructions or tendon transfer. Methods. A total of 21 eligible patients (mean age 34.0 years (standard deviation (SD) 11.2); mean follow-up period 31.8 months (SD 7.7), and 12 healthy controls (mean age, 26.8 years (SD 5.9) were included. For patients, clinical evaluation of the donor ankle was performed preoperatively and postoperatively. Square hop test, ankle strength assessment, and MRI of distal calf were assessed bilaterally in the final follow-up. The morphological symmetry of peroneal tendons bilaterally was evaluated by MRI in healthy controls. Results. Among the patients, the mean pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Karlsson-Peterson score were 98.7 (SD 2.5; p = 0.480) and 98.5 (SD 2.4; p = 0.480), and 98.3 (SD 2.4; p = 0.162) and 97.9 (SD 2.5; p = 0.162), respectively. There was no significant difference between square hop test bilaterally (p = 0.109) and plantar flexion peak force bilaterally (p = 0.371). The harvested limb had significantly less eversion peak force compared to the contralateral limb (p < 0.001). Evidence of probable tendon regeneration was observed in all the patients by MRI and the total bilateral peroneal tendon index (mean ratio of harvested side cross-sectional area of peroneal tendon compared with the contralateral side) was 82.9% (SD 17.4). In 12 healthy controls, peroneal tendons (mean 99.4% (SD 4.3) were found to be morphologically symmetrical between the two sides. Conclusion. The current study showed satisfactory clinical foot and ankle outcomes after full-thickness PLT harvesting and indicated the regenerative potential of PLT after its removal. Level of Evidence: Level IV, therapeutic retrospective case series. Cite this article: Bone Joint J 2020;102-B(2):205–211

Abstract. Introduction. Anterior cruciate ligament reconstruction (ACLR) can be performed with a number of different autografts including all soft tissue quadriceps autograft. (QT). QT has several advantages including decreased donor site morbidity, reduced anterior knee pain and comparable revision rates compared to other autografts. The primary aim of this review was to assess all complications of QT in adult population. Methodology. A systematic review of the literature was conducted on in accordance with the PRISMA guidelines using the online databases Medline and EMBASE. Clinical studies or reporting on soft tissue QT were included and appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results. Twelve studies were eligible, giving a total of 774 cases of QT ACLR. The mean age ranged from 18 to 45 years. The mean follow-up ranged from 12 to 55.6 months. Nine studies report on patients’ functional outcomes with mean IKDC score was 90.9 ±22.6 and Lysholm score of 88.6 ±6.5. Seven studies reported on complications which was overall 12.3% including 4.1% for graft site morbidity. Infection was reported in 0.4% of the patients. Seven studies reported on failure rate which was reported in 5.3%. Re-operation rate for any reason was 3.2 %. Conclusion. All soft tissue QT for ACLR has a low complication rate and revision rate. There is less graft site morbidity