allowing us to present our data, no disclosures for this study. We all know that ACL tears are common in athletes and that the rate of ACL tears is increasing at the professional college and high school levels. Although ACL tears have been studied extensively, the best graph for athletes really hasn't been defined. Most of us would agree that the BTB would be a gold standard for cutting and pivoting athletes. There's been an increase in interest in the quad autograft for ACL reconstruction over the past several years. The reason for this increase in interest in the quad really falls down to the flexibility of the graft and the biomechanical properties of the graft. X and his group at Emory studied the quad tendon, comparing it to the BTB for the biomechanical properties. They found that the cross-sectional area was two times that for the quad compared to the bone patella tendon autograft. They also found that the ultimate load to failure was significantly higher in the quad autograft as compared to the bone patella tendon autograft. The quad and BTB have been compared directly with each other in the general population. And typically the results of these studies have found that the quad tendon functions just as well as the BTB in the general population. However, very few studies have looked at the BTB versus the quad tendon in athletes. So the purpose of our study was to determine an all soft tissue quad autograft would compare to a bone patella tendon autograft for primary ACL reconstruction in cutting and pivoting athletes. We did a retrospective study of a single surgeon's experience over four years. We used high school and college athletes who were involved in cutting and pivoting sports. We limited the sports to football, soccer, basketball, and lacrosse. The athlete underwent an isolated primary ACL reconstruction with either an all soft tissue quad autograft or a bone patella tendon autograft with or without meniscal surgery. We followed the IKDC and lysosome scores preoperatively six months, 12 months, and 24 months after surgery. The primary clinical outcomes we looked at were return to sport and graft re-tears. Of note, all the patients in the study follow the same rehab protocols regardless of whether they had a quad or a BTB autograft. The quad autograft was created through a full thickness graft using all soft tissue. We used suspension fixation on both the tibial and femoral side. The bone patella tendon autograft was created with a 10 by 20 millimeter bone plug on both sides. I used suspension fixation for the femoral side and biocomposite interference screws for the tibial side. The demographics between the two groups are shown here. We had 32 patients in the quad group and 36 patients in the bone patella tendon group. The mean age, sex, and BMI were similar between the two groups as was the percentage of patients participating in high school and college athletics. The mean graft thickness or diameter of the graft was similar between the two groups. The number of patients undergoing meniscectomy versus meniscal repair were also similar between the two groups. This chart shows the IKDC scores throughout the entire study time period. You can see at the one and two year time periods that the scores were significantly higher than those of the preoperative levels. We can also see that at all time levels, there was no difference between the two groups with regards to the score. This is glycine scores throughout the two year time period. Again, we can see that there's no difference between the two with regards to the score. As far as clinical outcomes go, return to play was similar between the two groups with 88% returning for the quad group and 83% for the bone patella tendon group. Return to play at the same level was 65.6% for the quad group and 47.2% for the bone patella tendon group. This did lean towards significance, but did not reach it in the small group of patients. We did find a difference between the two groups with regards to the time to return to play. The average time to return to play for the quad group was 7.7 months compared to 9.1 months for the bone patella tendon group. This difference in 1.4 months was significantly different. We did not find a difference between the two groups with regards to the complications such as re-tear of the graft, contralateral ACL tear, or arthrofibrosis requiring surgical intervention. In conclusion, in the short term, quad tendon soft tissue autografts seem to function just as well as BTB autografts for ACL reconstruction cutting and pivoting athletes. We did find that quad tendon autografts in our small group of patients did return these athletes at a significantly shorter period of time than the bone patella tendon autograft. We feel that quad tendon autografts should be considered when discussing the surgical options with an athlete who participates in high-level cutting and twisting sports. Thank you.

ACL reconstruction

quad tendon autograft

bone patella tendon autograft

cross-sectional area

ultimate load to failure