Comparative Study between Minimally Invasive Quadriceps VS Hamstring Tendon Autografts in Arthroscopic ACL Reconstruction

Background: The anterior cruciate ligament (ACL) is crucial for knee stability, and its rupture is a common injury among young and active individuals. Autograft selection remains a key factor in optimizing surgical outcomes after ACL reconstruction. Objective: To compare the clinical and functional outcomes of arthroscopic ACL reconstruction using minimally invasive quadriceps tendon (QT) autografts versus hamstring tendon (HT) autografts. Patients and Methods: This prospective comparative study enrolled 30 patients with ACL-deficient knees who underwent single-bundle arthroscopic ACL reconstruction and were followed for two years. Patients were randomized into HT (n=15) and QT (n=15) groups. Outcomes were assessed using the Lysholm score (eight subscales and total), International Knee Documentation Committee (IKDC) criteria, Lachman test, pivot shift, functional leg hop test, and radiographic evaluation. Results: Both groups showed significant postoperative improvements. The median Lysholm total score increased from 66 (IQR: 60–73) to 96 (94–100) in the HT group and from 65 (56–73) to 98 (95–100) in the QT group (both P<0.001), with no significant intergroup difference (P=0.761). IKDC parameters including Lachman and pivot shift tests improved significantly within each group (P<0.001), while effusion and extension remained unchanged (P>0.05). Regression analysis revealed that older age (β=−0.58, P=0.017) and longer time-to-surgery (β=−0.31, P=0.042) were negatively associated with Lysholm score improvement, whereas concomitant medial (β=17.09, P=0.001) and lateral meniscal injuries (β=11.42, P<0.001), as well as higher preoperative activity level III (β=11.59, P=0.002), predicted greater improvement. Conclusion: Arthroscopic ACL reconstruction using either HT or QT autografts provides comparable functional and clinical outcomes.