Tendon-Bone Versus All-Soft-Tissue for ACL Reconstruction: A Patient-Blinded Randomized Clinical Trial

NCT ID: NCT04039971

Last Updated: 2025-04-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-08-01

Study Completion Date

2029-08-31

Brief Summary

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In primary pediatric Anterior cruciate ligament (ACL) reconstruction, the quadriceps tendon with either tendon and patellar bone or an all-tendon graft is commonly employed. However, no randomized control trial has sought to discern the superior graft option in regards to both short-term and long-term patient outcomes.The purpose of this study is to assess the differences between these two widely used surgical techniques in ACL reconstruction by examining short, intermediate, and long term outcomes of both approaches.

Detailed Description

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It is well known that ACL injuries are among the most common sports and knee injuries. As a result, ACL reconstruction is at the forefront both in terms of research and development and advancements in technique. One focus of research is graft choice and the risks and benefits associated with each. There are multiple valid graft choices including bone-patellar tendon-bone, hamstring tendon, quadriceps tendon, quadriceps tendon-patellar bone, and allograft. Graft choice is often patient centered and based on both patient and surgeon considerations such as age, sex, activity level, surgeon preference and graft associated complications.

The present study seeks to compare the intraoperative, immediate perioperative, intermediate and long-term outcomes between tendon-bone and all-soft-tissue quadriceps tendon autograft in ACL reconstruction in adolescent patients. The investigators will analyze data on operative time, cost, complications, recovery of strength and range of motion, return to sports rates, patient reported outcomes, and failure rates. With this proposal the investigators hope to determine if there is a superior graft technique in this population. Both graft types are validated in the literature separately as options for ACL reconstruction in this age group. There has been no clinical research comparing the two graft types, and therefore no consensus is made among surgeons on whether to use tendon-bone or all-soft-tissue when it comes to the QT autograft. A secondary aim of this study is to obtain patient reported outcomes throughout the post-operative period to determine if the patient experience is different between the two graft types. This data may be used in guiding a surgeon's decision on which type to use with their patients.

Conditions

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Anterior Cruciate Ligament Injuries Anterior Cruciate Ligament Rupture Anterior Cruciate Ligament Tear

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Tendon-Bone Graft

Participants receive the Quadriceps Tendon Tendon-Bone Graft technique during ACL reconstruction.

Group Type ACTIVE_COMPARATOR

ACL Reconstruction

Intervention Type PROCEDURE

Surgical techniques

All-Soft-Tissue Graft

Participants receive the Quadriceps Tendon All-Soft-Tissue Graft technique during ACL reconstruction.

Group Type ACTIVE_COMPARATOR

ACL Reconstruction

Intervention Type PROCEDURE

Surgical techniques

Interventions

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ACL Reconstruction

Surgical techniques

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Males and females
* Patients ages 12 to 19 (inclusive)
* Patients undergoing primary ACL reconstruction

Exclusion Criteria

* Patients with an underlying neuromuscular diagnosis or neurological injury
* Patients with lower extremity fractures, dislocations, or multi-ligamentous injuries, which required surgery, concurrent with or occurring two years or less prior to primary ACL injury.
* Patients with an underlying systemic or musculoskeletal diagnosis
Minimum Eligible Age

12 Years

Maximum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Children's Hospital Colorado

OTHER

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Stephanie Mayer, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital Colorado

Locations

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Children's Hospital Colorado

Aurora, Colorado, United States

Site Status

Countries

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United States

References

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Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Hewett TE, Flanigan DC; MOON Knee Group; Spindler KP. Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time. Arthroscopy. 2017 Nov;33(11):2007-2014. doi: 10.1016/j.arthro.2017.06.019. Epub 2017 Aug 26.

Reference Type BACKGROUND
PMID: 28847572 (View on PubMed)

Fineberg MS, Zarins B, Sherman OH. Practical considerations in anterior cruciate ligament replacement surgery. Arthroscopy. 2000 Oct;16(7):715-24. doi: 10.1053/jars.2000.8951.

Reference Type BACKGROUND
PMID: 11027755 (View on PubMed)

Middleton KK, Hamilton T, Irrgang JJ, Karlsson J, Harner CD, Fu FH. Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1. Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1467-82. doi: 10.1007/s00167-014-2846-3. Epub 2014 Feb 5.

Reference Type BACKGROUND
PMID: 24497054 (View on PubMed)

DeAngelis JP, Fulkerson JP. Quadriceps tendon--a reliable alternative for reconstruction of the anterior cruciate ligament. Clin Sports Med. 2007 Oct;26(4):587-96. doi: 10.1016/j.csm.2007.06.005.

Reference Type BACKGROUND
PMID: 17920954 (View on PubMed)

Crall TS, Gilmer BB. Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autograft. Arthrosc Tech. 2015 Dec 23;4(6):e841-5. doi: 10.1016/j.eats.2015.08.004. eCollection 2015 Dec.

Reference Type BACKGROUND
PMID: 27284521 (View on PubMed)

Lee S, Seong SC, Jo CH, Han HS, An JH, Lee MC. Anterior cruciate ligament reconstruction with use of autologous quadriceps tendon graft. J Bone Joint Surg Am. 2007 Oct;89 Suppl 3:116-26. doi: 10.2106/JBJS.G.00632. No abstract available.

Reference Type BACKGROUND
PMID: 17908877 (View on PubMed)

Ferrer GA, Miller RM, Murawski CD, Tashman S, Irrgang JJ, Musahl V, Fu FH, Debski RE. Quantitative analysis of the patella following the harvest of a quadriceps tendon autograft with a bone block. Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2899-2905. doi: 10.1007/s00167-015-3550-7. Epub 2015 Mar 7.

Reference Type BACKGROUND
PMID: 25749653 (View on PubMed)

Fink C, Herbort M, Abermann E, Hoser C. Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthrosc Tech. 2014 Aug 11;3(4):e509-13. doi: 10.1016/j.eats.2014.06.003. eCollection 2014 Aug.

Reference Type BACKGROUND
PMID: 25264512 (View on PubMed)

Sprowls GR, Robin BN. The Quad Link Technique for an All-Soft-Tissue Quadriceps Graft in Minimally Invasive, All-Inside Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2018 Jul 16;7(8):e845-e852. doi: 10.1016/j.eats.2018.04.004. eCollection 2018 Aug.

Reference Type BACKGROUND
PMID: 30167363 (View on PubMed)

Schulz AP, Lange V, Gille J, Voigt C, Frohlich S, Stuhr M, Jurgens C. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months. Open Access J Sports Med. 2013 Nov 19;4:243-9. doi: 10.2147/OAJSM.S49223. eCollection 2013.

Reference Type BACKGROUND
PMID: 24379730 (View on PubMed)

Gorschewsky O, Klakow A, Putz A, Mahn H, Neumann W. Clinical comparison of the autologous quadriceps tendon (BQT) and the autologous patella tendon (BPTB) for the reconstruction of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2007 Nov;15(11):1284-92. doi: 10.1007/s00167-007-0371-3. Epub 2007 Aug 25.

Reference Type BACKGROUND
PMID: 17721778 (View on PubMed)

Han HS, Seong SC, Lee S, Lee MC. Anterior cruciate ligament reconstruction : quadriceps versus patellar autograft. Clin Orthop Relat Res. 2008 Jan;466(1):198-204. doi: 10.1007/s11999-007-0015-4. Epub 2008 Jan 3.

Reference Type BACKGROUND
PMID: 18196393 (View on PubMed)

Kim SJ, Lee SK, Choi CH, Kim SH, Kim SH, Jung M. Graft selection in anterior cruciate ligament reconstruction for smoking patients. Am J Sports Med. 2014 Jan;42(1):166-72. doi: 10.1177/0363546513505191. Epub 2013 Oct 10.

Reference Type BACKGROUND
PMID: 24114749 (View on PubMed)

Kim SJ, Kumar P, Oh KS. Anterior cruciate ligament reconstruction: autogenous quadriceps tendon-bone compared with bone-patellar tendon-bone grafts at 2-year follow-up. Arthroscopy. 2009 Feb;25(2):137-44. doi: 10.1016/j.arthro.2008.09.014. Epub 2008 Nov 20.

Reference Type BACKGROUND
PMID: 19171272 (View on PubMed)

Streich NA, Barie A, Gotterbarm T, Keil M, Schmitt H. Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes. Knee Surg Sports Traumatol Arthrosc. 2010 Nov;18(11):1481-6. doi: 10.1007/s00167-010-1057-9. Epub 2010 Feb 4.

Reference Type BACKGROUND
PMID: 20130837 (View on PubMed)

Other Identifiers

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19-1445

Identifier Type: -

Identifier Source: org_study_id

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