Evidence map›Paper›PMID 42098886›Full record

ReviewKnee surgery & related research2026

Clinical outcomes of quadriceps, hamstring, and bone-patellar tendon-bone autografts for ACL reconstruction: a meta-analysis of randomized controlled trials.

Riccardo D'Ambrosi, Luca Farinelli, Piero Franco, Andrea Marchetti, Amit Meena, Danko Dan Milinkovic, Srinivas Bs Kambhampati, Luca Maria Sconfienza, Thomas Patt, Chiara Ursino and 2 more

Abstract readReview
In one paragraph

Review in Knee surgery & related research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Riccardo D'AmbrosiIRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy. riccardo.dambrosi@hotmail.it.
Luca FarinelliMarche Polytechnic University, Ancona, Italy.
Piero FrancoAzienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Andrea MarchettiUniversity of Trieste, Trieste, Italy.
Amit MeenaShalby Hospital, Jaipur, India.
Danko Dan MilinkovicCharité - University Medicine Berlin, Berlin, Germany.
Srinivas Bs KambhampatiSri Dhaatri Orthopaedic, Maternity & Gynaecology Center SKDGOC, Vijayawada, India.
Luca Maria SconfienzaIRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
Thomas PattBergman Clinics, The Hague, Netherlands.
Chiara UrsinoIRCCS Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy.
Elisabeth AbermannGelenkpunkt, Innsbruck, Austria.
Christian FinkGelenkpunkt, Innsbruck, Austria.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe quadriceps tendon (QT) has emerged as a reliable autograft for anterior cruciate ligament reconstruction (ACLR), but uncertainty remains regarding several key comparative aspects-particularly donor-site morbidity, long-term graft survival, knee stability, and complication rates-when evaluated against hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts. High-level evidence restricted to randomized controlled trials directly comparing QT with HT or BPTB remains limited. To compare clinical outcomes, graft failure, donor-site morbidity, and knee stability among QT, HT, and BPTB autografts for primary ACLR using level-I and level-II randomized controlled trials (RCTs).

methodsThe MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library databases were searched on 1 September 2025, and repeated 2 weeks later. Only level-I or -II RCTs comparing QT to HT or BPTB in primary ACLR were included. Random-effects meta-analyses were performed for International Knee Documentation Committee (IKDC) and Lysholm scores, instrumented laxity, graft failure, donor-site morbidity, and reoperation. Risk of bias was assessed with RoB 2.0, and small-study effects with funnel and doi plots.

resultsEleven RCTs (mean follow-up, 2-10 years) were included. Pooled IKDC scores averaged 84.8 (95% CI 81.9-87.9) and Lysholm scores averaged 93.1 (95% CI 91.6-94.6), with no significant differences between QT and either comparator (P > 0.05). Side-to-side anterior tibial translation averaged 1.2 mm (95% CI 0.99-1.54 mm) across all grafts, also without significant differences (P > 0.05). Pooled graft failure and ipsilateral reoperation rates were 0.7% (95% CI 0.0-1.9%) and 2.3% (95% CI 0.6-4.7%), respectively, again with no between-graft differences (P > 0.05). Donor-site morbidity did not differ significantly between QT and HT (mean 13.83 [95% CI 9.6-19.83]; P > 0.05).

conclusionThis meta-analysis of level-I/II randomized controlled trials found no statistically significant differences among quadriceps tendon, hamstring tendon, and bone-patellar tendon-bone autografts in patient-reported outcomes, knee stability, graft re-rupture, or additional knee surgery. Donor-site morbidity comparisons were limited by incomplete reporting, particularly for BPTB. These findings suggest that contemporary surgical techniques and rehabilitation protocols may minimize graft-specific differences in mid-term outcomes, although interpretation should consider the limited number of direct comparative trials across all three graft types. Level of evidence Systematic review and meta-analysis; level of evidence, 1 and 2.

Indexed as

Anterior cruciate ligament reconstructionBone–patellar tendon–bone autograftDonor-site morbidityGraft failureHamstring tendon autograftMeta-analysisQuadriceps tendon autograftRandomized controlled trials

Identifiers

PMID42098886
PMCPMC13154517

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.