Thank you for the introduction. I'd like to thank my co-authors for their help with this project. These are disclosures. There's no relevance for this talk. So what we've seen in revision setting is a high use of the quadriceps tendon, 49% from 2015 to 2020, which is up a lot from 18% from the five years prior. There's limited available evidence currently using the free tendon, and these studies show that almost 20% were after a second revision surgery. The study used a variety of primary graphs and secondary procedures such as ALL, and the study showed about 13.8% failure at about 42 months, and it had limited functional assessment. So we want to know, is the quadriceps tendon autograph a good graph to use after a failed primary BTB autograph reconstruction? So will this restore the quadriceps function? Can we limit the complications, and can we facilitate the return to sport and prior function? So our purpose was to look at the free quadriceps graph after the failed BTB reconstruction. We're going to look at self-reported patient outcomes, what their quadriceps strength was post-op, and any rate of complications, and we hypothesized that we would get good strength back. The re-injury rates will be low, and there will be a high rate of return to function in an athletic population. So this was a retrospective study looking at ages of 15 to 55 with an intention to return to sport at the time of surgery. We did exclude municipal transplant, bicruciate surgery, fracture, and malignancy. So this was a retrospective design using a single surging cohort, and after our exclusion criteria, we're down to 48 patients with three loss to follow-up, so we had a total patient population of 45. So these were our evidence-based return to sport outcomes, looking at the comparison to the contrail limb before returning them to sport, and we were looking at isokinetic knee strength as well. So at two years, we were looking at their patient-reported SANE scores, looking at what the graph re-injury rate was, what their other complications were, such as knee pain, infection, DVT, loss of motion, and we also wanted to know what their level of participation was at return to sport. So we ran a descriptive statistical analysis, and looking at our demographics, the average age was 23.9, and they had a pre-op mark score of 10.8, showing that it was an active patient population. The majority of these did have meniscus repair at the time of surgery, a quarter had chondroplasty, and one-third were staged procedures. And we had an average 8.9 months return to sport. We had high IKDC and ACLRSI scores, and all our return to play functions showed 94% or greater compared to the other limb. Looking at the isokinetic quadriceps strength at time of return to play, we were able to obtain the 90% threshold at the 300 degree per second test, and then looking at our 60 and 180 degrees, we were in the 80s, which is consistent with the literature, which was done at 12 months. Our SANE scores, we obtained 88.9% on average at two years, and 65% of patients were able to return to level one or level two studies activity. For two-year complications, we did have three graft failures, five people had anterior knee pain, two had loss of motion, two had DVT, and one had meniscal tear and removal of hardware. So, for our hypothesis, we were able to show good quadriceps strength at two years based on the isokinetic quad strength testing and the return to play function. We had low graft failure rates and a high return to function, 97% were able to return to at least level three participation. Comparing to the prior study for the free quadriceps tendon, so our graft failure rate was low, so their two-year failure rate was 8.8, but their all-comer at 42 months was 13.8. Our self-reported function, IKDC, was also comparable to that study. Looking at revision BTB autographs, their SANE scores were reported at 74.8, which ours was 88.9, and looking at the isokinetic quad strength at 180 degrees per second, it was comparable to the literature for revision quad tendon. So, we were able to look at an athletic sample with specifically failed patellar tendon autographs, ACL reconstruction. The treating surgeon did not perform all the primary reconstructions, and this was a retrospective study design. So, we do think that this free quadriceps tendon autograph will maintain the integrity of the extensor mechanism. Most patients should be able to return to high function, will restore the knee extension strength, and will have low graft failure and complication rates. Thank you.

quadriceps tendon autograft

revision surgeries

patient-reported outcomes

complications

athletic patients