Anterior cruciate ligament reconstruction with a quadriceps tendon autograft in female patients shows equivalent graft failure but lower activity scores and slower quadriceps strength recovery compared with male patients: a systematic review and meta-analysis.
Sharma, Anirudh Tahir, Muaaz Aweid, Osama Boutefnouchet, Tarek Sweed, Tamer Meena, Amit de Sa, Darren L Frank, Rachel M D'Alessandro, Peter Malik, Shahbaz S
Sharma, Anirudh
Tahir, Muaaz
Aweid, Osama
Boutefnouchet, Tarek
Sweed, Tamer
Meena, Amit
de Sa, Darren L
Frank, Rachel M
D'Alessandro, Peter
Malik, Shahbaz S
Abstract
BACKGROUND: The use of a quadriceps tendon (QT) autograft has gained popularity in recent years, and it has been called the "graft of the future." However, there is limited evidence of its sex-specific outcomes in female patients.
PURPOSE: To assess the outcomes of anterior cruciate ligament reconstruction (ACLR) with a QT autograft specifically in female patients and to elucidate any differences in sex-specific outcomes compared with male patients.
STUDY DESIGN: Systematic review; Level of evidence, 2.
METHODS: This systematic review was conducted in accordance with PRISMA guidelines using 4 online databases for a review of the literature. Studies using a QT autograft for ACLR but not reporting female-specific outcomes were excluded. Outcomes assessed included patient-reported outcomes, objective functional outcomes, and complications. A meta-analysis was performed in which data allowed for a comparison of outcomes with male patients.
RESULTS: There were 9 studies included in this review, with a total of 714 female knees (mean age, 23.0 years) that underwent ACLR with a QT autograft. No difference was observed in the pooled graft failure rate between male and female patients at ≥24 months (8.8% vs 7.4%, respectively; = .50). Female patients had lower Tegner scores at 24 months ( = .0007) and a lower quadriceps strength limb symmetry index at 6 months ( < .0001). No significant difference was seen in the side-to-side difference in instrumented laxity measurements at 6 months ( = .44) or in Lysholm scores at 24 months ( = .52). The mean extension loss in female patients was 0.07° (range, -0.22° to 0.58°) at 24 months. The return-to-sport rate in female patients ranged from 71.4% to 82.7%.
CONCLUSION: Evidence from currently available literature suggests that there is no difference in graft failure rates between the sexes after ACLR with a QT autograft. Additionally, female patients have lower activity scores and slower quadriceps recovery compared with male patients.
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Date
2026-01-12
Type
Article
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Citation
Sharma A, Tahir M, Aweid O, Boutefnouchet T, Sweed T, Meena A, de Sa DL, Frank RM, D'Alessandro P, Malik SS. Anterior Cruciate Ligament Reconstruction With a Quadriceps Tendon Autograft in Female Patients Shows Equivalent Graft Failure But Lower Activity Scores and Slower Quadriceps Strength Recovery Compared With Male Patients: A Systematic Review and Meta-analysis. Am J Sports Med. 2026 Mar;54(3):712-723. doi: 10.1177/03635465251376649. Epub 2026 Jan 12.