Anterior Cruciate Ligament (ACL) Injury

Quadriceps Tendon (QT)

Advantages:

Large volume of tissue to use.

Can be readily harvested.

Superior biomechanical characteristics c/f hamstrings and BPTB grafts.

Low donor site morbidity.

Quadriceps Tendon (QT)

7 to 8.5cm in length from superior pole of patella extending proximally to the myotendinous junction of the rectus femoris.

The width of the tendon is 2.5 to 3cm.

The tendon diameter is largest at the insertion to the patella. It is 16mm (females) to 18mm (males).

Can harvest tendon only or tendon with patella bone block.

Quadriceps Tendon Graft for ACL Reconstruction

Biomechanical Properties of QT

Clinical Results of QT Graft for ACL Reconstructions

Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years.

Etienne Cavaignac et al. , AJSM

Background: The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft.

Hypothesis: The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.

Study design: Cohort study; Level of evidence, 3. Methods: Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test.

Results: Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength.

Conclusion: The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.

Quadriceps tendon autograft for ACL reconstruction: Evidence for increased utilization.

Hazzard, Sean, PA‐C. JBJS Journal of Orthopaedics for Physician Assistants: October 2014 – Volume 2 – Issue 4 – p 14-16

Purpose: To review the current literature of quadriceps tendon (QT) autograft tissue for ACL reconstruction and assess its evidence to become a more mainstream graft option

Methods: A database review of clinical studies involving quadriceps tendon autograft tissue for ACL reconstruction was compared to results of ACL reconstructions using BTB and hamstring autograft tissue.

Results: 20 articles were noted totaling 1,686 reconstructions including 6 studies which compared QT to either hamstring or BTB grafts. Quadriceps tendon grafts reported significantly less anterior knee pain (3.8%) compared to BTB (17.4%) and hamstring (11.5%) while providing clinical stability, adequate amount of graft tissue, and subjective outcomes comparable to traditional BTB and HS autograft options.

Conclusions: Quadriceps tendon autograft is a strong and clinically proven alternative to BTB and hamstring autografts while decreasing graft site morbidity and should be considered a first line ACL graft option.

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