# Donor-Site Morbidity in Anterior Cruciate Ligament (ACL) Reconstruction With All-Soft Tissue Quadriceps Tendon Autograft vs. Hamstring Tendon Autograft: A Retrospective Monocentric Observational Study

## TL;DR

This study compares donor-site morbidity after ACL reconstruction using quadriceps tendon or hamstring tendon autografts, finding better outcomes with quadriceps tendon grafts.

## Contribution

The study provides new evidence on donor-site morbidity comparing quadriceps tendon and hamstring tendon autografts in ACL reconstruction.

## Key findings

- Quadriceps tendon autografts showed superior donor-site morbidity outcomes compared to hamstring tendon grafts.
- Significant differences were found in numbness and muscle atrophy favoring the quadriceps tendon group.
- Female sex and low mood were associated with increased donor-site morbidity.

## Abstract

Background: Graft choice, together with operative technique, remains the most controversial topic surrounding ACL reconstruction. The ideal graft choice should recreate normal anatomy and biomechanics, allow for rapid return to play and have minimal harvest-site morbidity. The purposes of this study were to compare donor-site morbidity in all-soft-tissue quadriceps autograft vs. hamstring autografts based on Hacken et al.'s ACL Donor-Site Morbidity Questionnaire (32,587,874) and to assess the role played by external factors such as sex, mood, activity level and smoking status.

Materials and Methods: We performed a retrospective analysis of our patients' records to identify individuals who were 30 years old or younger at the time of surgery and underwent ACL reconstruction using the anteromedial portal technique, without any additional treatments for ligament or meniscal injuries. At 12 months postintervention, donor-site morbidity was evaluated using the ACL donor-site morbidity questionnaire by Hacken et al. (2020). Analyses were performed using Jamovi freeware Version 2.3.19.0 (the Jamovi project, 2021). Independent samples t-test with Cohen's d as the effects' size statistics were used to compare donor-site morbidity and functional outcomes.

Results: Significant differences between quadriceps tendon (QT) and STG groups were found for ACL donor-site morbidity questionnaire total score, numbness, size of numbness and muscle atrophy, all in favour of the QT cohort. Weak associations were found between female sex and low mood, both negatively impacting the reported donor site morbidity. No statistically significant differences were found for functional outcomes.

Conclusion: ACL reconstruction with all-soft-tissue QT autograft showed overall superior donor-site morbidity outcomes when compared with HT autograft. Statistically significant results were also found in favour of QT when comparing numbness and size of numbness at the donor site and self-perceived muscle atrophy. Female sex and low mood have been found to impact donor-site morbidity negatively although larger samples are necessary to confirm this association. Graft choice in ACL reconstruction should always remain an individualized choice, but QT should be considered an equal, if not superior, alternative to other autologous autografts when comparing donor-site morbidity.

Trial Registration: CINECA: 6458