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
Affiliation
Other Contributors
Publication date
2026-01-12
Collections
Research Projects
Organizational Units
Journal Issue
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.
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 Jan 12:3635465251376649. doi: 10.1177/03635465251376649. Epub ahead of print.
Type
Article