ReviewIndian journal of orthopaedics2025
Quadriceps Tendon Graft Leads to Stronger Flexion and Weaker Extension of the Knee Than Hamstring Graft Post-ACLR: Systematic Review and Meta-Analysis.
Review in Indian journal of orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Corrections and comments
- Erratum issued
Authors and funding
8 authors.
Funding
Abstract
Purpose: The optimal autograft for restoring knee strength and expediting return-to-sport following anterior cruciate ligament reconstruction (ACLR) remains debated. This systematic review and meta-analysis compared isokinetic strength and patient-reported outcomes after ACLR using quadriceps tendon (QT), hamstring tendon (HT), or bone-patellar tendon-bone (BTB) autografts to determine graft-specific recovery patterns. Methods: PubMed, Cochrane Library, EMBASE, and Google Scholar were systematically searched for comparative studies evaluating isokinetic strength following primary ACLR using QT, HT, or BTB autografts. Non-English, unavailable full-text, animal/cadaveric, and physeal-sparing studies were excluded. MINORS and Detsky evaluated bias risk. Key findings were quantified, and subgroup meta-analyses were performed on limb symmetry index (LSI) values (significance: Results: Seventeen studies (1,705 patients: QT = 765, HT = 725, BTB = 215) with follow-ups through 48 months were included. Due to data heterogeneity, four to six studies qualified for each meta-analysis. Among 13 QT vs. HT studies, QT grafts demonstrated weaker extensor strength in nine (56.3%) and greater flexor strength in six (37.5%). No differences were reported in extensor or flexor strength in four (25.0%) and seven (43.8%) studies, respectively. For QT vs. BTB, two studies (12.5%) showed similar extensor strength, whereas two reported conflicting results. QT had greater flexor strength in one (6.3%) and similar strength in three (18.8%) studies. Postoperative pain was comparable between QT and HT. Conclusions: QT autografts resulted in stronger flexion and weaker extension than HT autografts after ACLR. Tailored rehabilitation targeting graft-specific deficits may accelerate recovery. Further research is required to clarify outcomes between QT and BTB autografts.
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