Quadriceps Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction Has No Difference in Short‐Term Clinical Outcomes Between All‐Soft Tissue Versus Tendon–Bone Grafts: A Systematic Review
Arthroscopy The Journal of Arthroscopic and Related Surgery · 29 Oct 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Quadriceps tendon autograft is increasingly used for ACL reconstruction, and choosing whether to take a patellar bone block is a common intraoperative decision with trade-offs between bone healing and patellar fracture risk.
The evidence
This systematic review compared two ways of harvesting quadriceps tendon autograft for primary ACL reconstruction: all-soft tissue (ST-QT) versus with a patellar bone block (QT-B), pooling five comparative studies (one RCT, four observational) totaling 996 ST-QT and 1279 QT-B knees. Graft failure ranged from about 2.4% to 7.6% with ST-QT and 2.75% to 6.4% with QT-B, and no individual study found a significant difference; two intraoperative patellar fractures occurred, both in the QT-B arm of one small trial. One large registry study found better KOOS Symptoms and Sport scores with ST-QT but a higher rate of positive pivot shift (44.8% vs 21.8%), and no pooled estimate was calculated.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Meta-analysis (mixed designs)Design starting point: 42.6
Raised the score
- Comprehensive literature search+3.4
- Risk of bias assessed in the included studies+3.4
Lowered the score
- Pools mixed study designs−3.4
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedNot met
- Study exclusions justifiedNot met
- Prospective registrationNot reported
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 42.6
- Compared against an accepted alternative
- +1.7
- Pools mixed study designs
- −3.4
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Final rigour score rounded
- 50 / 100
Study design sets the starting point and a ceiling of 82. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given that one large registry found nearly twice the rate of positive pivot shift with all-soft tissue quadriceps grafts, would you add a lateral extra-articular procedure or prefer a bone block in high-demand pivoting athletes?
2.How would you counsel a young patient about the small risk of patellar fracture with a quadriceps bone-block graft versus the theoretical slower tendon-to-bone healing of an all-soft tissue graft?
Original publication title
Quadriceps Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction Has No Difference in Short‐Term Clinical Outcomes Between All‐Soft Tissue Versus Tendon–Bone Grafts: A Systematic Review