Publication:

Critical evaluation of the parameters used in randomized controlled trials of quadriceps tendon, bone-patellar tendon-bone, and hamstring tendon for anterior cruciate ligament reconstruction: a systematic review

Anterior cruciate ligament (ACL) reconstruction using autologous quadriceps tendon (QT), bone-patellar tendón-bone (BPTB), and hamstring tendon (HT) grafts has been extensively investigated in randomized controlled trials (RCTs). However, few systematic reviews have analyzed how functional and stability outcomes are measured or the methodological consistency of the evaluation tools employed. Objectives were to systematically review RCTs comparing QT, BPTB, and HT grafts for ACL reconstruction, emphasizing the assessment methods, parameters used, and methodological limitations. Eleven RCTs were included. Functional scales (IKDC, Lysholm, Tegner, KOOS), stability tests (Lachman, pivot-shift, KT-1000), pain and strength measurements, and follow-up duration were analyzed. Methodological consistency, completeness of outcome reporting, and comparability between studies were also assessed. Eleven RCTs comprising 692 patients were analyzed. Comparable clinical efficacy was observed among QT, BPTB, and HT grafts regarding joint stability and function. Nevertheless, significant heterogeneity existed in evaluation tools. Objective assessments such as quadriceps strength, KT-1000 anterior translation, and MRI follow-up were inconsistently reported. Most studies relied primarily on patient-reported outcome measures (PROMs) such as Tegner, Lysholm, and IKDC, without standardized timing or threshold values, limiting interstudy comparability. This review highlights substantial methodological variability in how clinical and functional outcomes are evaluated after ACL reconstruction. Beyond clinical equivalence among grafts, there is a pressing need to establish standardized, objective, and comprehensive assessment protocols to enhance the quality, reproducibility, and clinical relevance of future comparative trials.