Adolescent ACL Reconstruction Using Quadriceps or Hamstring Tendon Autografts: A Comparative Study of Muscle Strength and Patient-Reported Outcomes

<b>Background and Objectives:</b> A prominent area of research in adolescent ACL reconstruction (ACLR) involves graft selection, with particular interest in the quadriceps tendon (QT) as an alternative to hamstring tendon (HT) autografts, although comparative studies on muscle strength outcomes and patient satisfaction in adolescents remain limited. This study aims to evaluate the influence of QT and HT autografts on muscle strength and satisfaction outcomes post-ACLR in adolescents. <b>Methods:</b> This prospective study was conducted at the Lithuanian University of Health Sciences, enrolling 68 patients aged 12-17. ACLRs were performed using QT or HT autografts. Muscle strength was assessed using an isokinetic dynamometer (Biodex), while patient satisfaction was evaluated through IKDC, Lysholm, and ACL-RSI surveys preoperatively and 12 months postoperatively. <b>Results:</b> 54 patients (24 QT and 30 HT) completed the study. The data are non-parametric and are presented as median (IQR). Isokinetic measurements indicated that QT harvesting led to significantly lower extension strength compared to HT 6 months (<i>p</i> = 0.019) and 12 months post-op (<i>p</i> < 0.001) but showed better H/Q ratios 6 months (<i>p</i> = 0.019) and 12 months post-op (<i>p</i> < 0.001). There was no significant difference between the QT and HT groups in ACL-RSI and Lysholm scores. IKDC scores were significantly higher in the HT group (<i>p</i> = 0.009). <b>Conclusions:</b> QT autografts provide favorable H/Q ratios, yet they exhibit weaker extension strength and lower satisfaction outcomes compared to HT. These results suggest a need for individualized rehabilitation protocols and further research to optimize ACLR graft selection for adolescents.