Earlier strength recovery with partial‐thickness versus full‐thickness quadriceps tendon graft for anterior cruciate ligament reconstruction in competitive soccer players

PURPOSE: This study aimed to compare strength recovery, functional and clinical outcomes between full- and partial-thickness quadriceps tendon autografts for 12 months post-operatively and to examine the clinical implications of graft thickness in anterior cruciate ligament reconstruction among non-professional competitive soccer players. METHODS: 42 non-professional competitive Spanish federal soccer players who underwent primary anterior cruciate ligament reconstruction using either full- or partial-thickness quadriceps tendon grafts were included in this retrospective cohort study. Both groups followed standardised surgical and rehabilitation protocols. Evaluations were assessed preoperatively and at 3, 6 and 12 months post-operatively, with the reinjury rates recorded at 24 months. Quadriceps index, measured by isokinetic dynamometry was the primary outcome. Hamstring index, extension and flexion peak torque, single leg hop test, patient-reported outcome measures (Lysholm and Cincinnati Knee Rating System scores) and reinjury rate were evaluated as secondary outcomes. Statistical analysis was performed using repeated-measures ANCOVA with a Bonferroni adjustment, and the significance level was set at 5%. RESULTS: During the first 6 months, faster recovery of quadriceps symmetry was observed in partial-thickness group compared to the full-thickness group at 300°/s (mean difference: -26.5, 95% confidence interval [CI] [-51.4, -1.7], p = 0.037), 180°/s (mean difference: -31.0, 95% CI [-56.0, -6.0], p = 0.017), and 60°/s (mean difference: -31.2, 95% CI [-55.4, -7.0], p = 0.013), as well as greater improvement in extension peak torque. No statistical differences (p > 0.05) remained between groups at 12 months, with both groups achieving similar recovery. Hop test and clinical outcomes improved significantly over time in both groups, without significant between-group differences (p > 0.05). Reinjury rate was similar between groups (p = 0.634). CONCLUSIONS: Earlier strength recovery was observed with partial-thickness graft after ACL reconstruction, highlighting the clinical relevance of graft choice in early rehabilitation in competitive soccer players. LEVEL OF EVIDENCE: Level II.