Similar Outcomes but Significantly Different Donor Site Morbidity Profiles After Autograft Quadriceps and Bone–Patellar Tendon–Bone Anterior Cruciate Ligament Reconstruction

PURPOSE: To compare differences in donor site morbidity (DSM) following quadriceps tendon (QT) autograft and bone-patellar tendon-bone (BPTB) autograft anterior cruciate ligament reconstruction (ACLR) at 2 year follow-up. METHODS: Patients who underwent primary ACLR with QT autograft between January 2018 and February 2020 were identified in a single institution registry and matched on the basis of age and sex to a control group of BPTB autograft ACLR patients. Patients were contacted at a minimum of 2 years postsurgery to evaluate DSM, Patient Reported Outcome Measures (PROMs), Return to Sport (RTS), and reoperation. RESULTS: Fifty QT patients (mean age 22.6 years) and 88 BPTB patients (mean age 22.8 years) were included (mean follow-up 31.1 months; range 24.1-56.2). Total DSM score was similar between QT and BPTB patients (87.2 vs 84.2, P = .343); however, BPTB patients exhibited less quadriceps wasting/atrophy, but QT patients had less pain at the donor site, numbness, and pain with kneeling. Female sex was an independent predictor of inferior DSM score (Estimate: -6.4, P = .04), and quadriceps wasting/atrophy was worse in female QT than BPTB patients (Estimate: -2.90, P < .0001). There were no significant differences between QT and BPTB patients in PROMs. 87% of QT patients and 74% of BPTB patients returned to sports (P = .093). There was a higher rate of ipsilateral reoperation in the QT group compared with the BPTB group (26% vs 10%, P = .016), but no differences in reoperation for ipsilateral graft failure or contralateral ACL rupture between groups. CONCLUSIONS: Our findings suggest that overall, the QT autograft was associated with significantly less donor site pain, numbness, and pain with kneeling, but more quadriceps wasting/atrophy than BPTB autografts in patients undergoing primary ACLR. These distinct DSM profiles, along with observed differences in quadriceps wasting/atrophy between sexes, should guide patient education accordingly. LEVEL OF EVIDENCE: Level III, retrospective comparative case series.