The quadriceps tendon autograft is an option for primary PCL reconstruction: a systematic review
Bibliographic record
Abstract
IMPORTANCE: The posterior cruciate ligament (PCL) is involved in almost one-third of all knee injuries. Surgical management of PCL injuries is currently controversial, and no single graft material is determined as superior in primary PCL reconstruction. A growing body of literature has demonstrated the safety and versatility of the quadriceps tendon (QT) autograft in arthroscopic knee ligament reconstruction. OBJECTIVE: The objective of the study was to assess the QT autograft for use in primary PCL reconstruction with a focus on complication rates, revision rates, and functional outcomes. EVIDENCE REVIEW: The online databases Medline, Embase, Web of Science, and CENTRAL were searched on April 30, 2020. Retrieved records were screened by two independent reviewers. Eligible studies assessed the QT autograft in skeletally mature participants undergoing primary PCL reconstruction. Studies of multiligamentous repairs and revisions were excluded. A narrative summary of results from individual studies is presented. FINDINGS: Six articles met inclusion criteria with n = 119 participants (21% female) and a follow-up range from 12 months to 84 months. Complication rates ranged from 13% to 65% and included moderate (n = 4) and mild (n = 4) knee pain, reflex sympathetic dystrophy (n = 3), joint space narrowing (n = 3), superficial wound infections (n = 2), complex regional pain syndrome (n = 2), and flexion deficiency (n = 2). Revision rates ranged from 0% to 15% and included hardware removal (n = 4), manipulation under anaesthesia (n = 2), arthroscopic arthrolysis (n = 2), and arthroscopic refixation (n = 2). Subjective International Knee Documentation Committee scores increased from a preoperative range of 37.7 ± 21.4 to 39.5 ± 21 to a postoperative range of 74.5 ± 17.7 to 84.7. Lysholm scores, Tegner activity scores, and posterior tibial laxity also demonstrated improvements postoperatively. No statistically significant differences were reported in the study that compared the QT autograft with the hamstring tendon autograft. CONCLUSIONS AND RELEVANCE: This systematic review reported functional outcomes and complication rates of a small QT autograft sample that were comparable with other graft materials used in PCL reconstruction. Heterogeneity of the included studies and reported outcomes precluded meta-analysis. Future studies of better methodological quality and larger sample sizes need to be conducted before the QT autograft may be concluded as safe and effective in primary PCL reconstruction. LEVEL OF EVIDENCE: IV.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.009 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".