(65) 8896 3604

Call Us
(65) 6836 6636

(65) 8896 3604

Call Us
(65) 6836 6636

Anterior Cruciate Ligament (ACL) Injury

Quadriceps Tendon (QT)


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.


  1. Harris N.L., Smith D.A., Lamoreaux L., et al: Central quadriceps tendon for anterior cruciate ligament reconstruction. Part I: morphometric and biomechanical evaluation. Am J Sports Med 25. (1): 23-28.1997
  2. 2. Staubli H.U., Schatzmann L., Brunner P., et al: Mechanical tensile properties of the quadriceps tendon and patellar ligament in young adults. Am J Sports Med 27. (1): 27-34.1999
  3. Noyes F.R., Butler D.L., Grood E.S., et al: Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 66. (3): 344-352.1984
  4. Hamner D.L., Brown Jr. Jr.C.H., Steiner M.E., et al: Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81. (4): 549-557.1999
  5. Woo S.L., Hollis J.M., Adams D.J., et al: Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 19. (3): 217-225.1991
  6. Geib T.M., Shelton W.R., Phelps R.A., et al: Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy 25. (12): 1408-1414.2009
  7. Feller J, Webster K (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction.Am J Sports Med 31:564-573
  8. Freedman K.B., D’Amato M.J., Nedeff D.D., et al: Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31. (1): 2-11.2003
  9. Lee S., Seong S.C., Jo H., et al: Outcome of anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthroscopy 20. (8): 795-802.2004
  10. Nakamura N., Horibe S., Sasaki S., et al: Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18. (6): 598-602.2002
  11. Christen B., Jakob R.P.: Fractures associated with patellar ligament grafts in cruciate ligament surgery. J Bone Joint Surg Br 74. (4): 617-619.1992
  12. Viola R., Vianello R.: Three cases of patella fracture in 1,320 anterior cruciate ligament reconstructions with bone-patellar tendon-bone autograft. Arthroscopy 15. (1): 93-97.1999
  13. Mulford J., Hutchinson S., Hang J.: Outcomes for primary ACL reconstruction with quadriceps autograft: a systemic review, Knee Surg Sports Traumatol Arthrosc 21 (8) 1882-1888. 2013
  14. Johnson RJ, Beynnon BD, Nichols CE: The treatment of injuries of the anterior cruciate ligament [current concepts review]. J Bone Joint Surg 74A:140-151,1992
  15. Magnussen RA, Carey JL, Spindler KP: Does autograft choice determine intermediate-term outcome of ACL reconstruction?, Knee Surg Sports Traumatol Arthrosc 19:462-472. 2010
  16. Chen CH, Chou SW, Chen WJ, Shih CH, Ueng WN Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft-minimal 4-year follow-up (SS-14). Arthroscopy 20:e7. 2006
  17. Chen CH, Chen WJ, Shih CH Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. J Trauma 46:678-682. 1999
  18. Chen CH, Chuang TY, Chen LH, Chen WJ, Chen CH Comparison of quadruple hamstring graft and quadriceps (SS-05). Arthroscopy 19:SS-05. 2003
  19. DeAngelis JP, Fulkerson JP, Quadriceps tendon-a reliable alternative for reconstruction of the anterior cruciate ligament. Clin Sports Med 26:587-596. 2007
  20. Geib T, Shelton WR, Arthroscopic Anterior cruciate ligament reconstruction utilizing quadriceps tendon autograft: intermediate results (SS-32). Arthroscopy 24:e17-e18. 2008
  21. Gorschewsky O, Stapf R, Geiser L, Geitner U, Neumann W. Clinical comparison of fixation methods for patellar bone quadriceps tendon autografts in anterior cruciate ligament reconstruction: absorbable cross-pins versus absorbable screws. Am J Sports Med 35:2118-2125. 2007
  22. Han HS, Seong SC, Lee S, Lee MC. Anterior cruciate ligament reconstruction: quadriceps versus patellar autograft. Clin Orthop Relat Res 466:198-204. 2008
  23. Kim SJ, Jo SB, Kumar P, Oh KS. Comparison of single- and double-bundle anterior cruciate ligament reconstruction using quadriceps tendon-bone autografts. Arthroscopy 25:70-77. 2009
  24. 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 25:137-144. 2009
  25. 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 89(Suppl 3):116-126. 2007
  26. Leitman EH, Morgan CD, Grawl DM. Quadriceps tendon anterior cruciate ligament reconstruction using the all-inside technique. Op Tech Sports Med 7:179-188. 1999
  27. Noronha JC. Reconstruction of the anterior cruciate ligament with quadriceps tendon. Arthroscopy 18:E37p1-E37p5, 2002
  28. Sarrafan N, Mehdinasab SA. Anterior cruciate ligament reconstruction using the patella tendon and quadriceps tendon: a comparative study. Pak J Med Sci 24:416-419. 2008
  29. Shelton WR, Holt S. Quadriceps tendon anterior cruciate ligament reconstruction (SS-15). Arthroscopy 20:e7. 2004
  30. Stanish WD, Kirkpatrick J, Rubinovich RM. Reconstruction of the anterior cruciate ligament with a quadricep patellar tendon graft. Preliminary results. Can J Appl Sport Sci 9:21-24. 1984
  31. Theut PC, Fulkerson JP, Armour EF, Joseph M. Anterior cruciate ligament reconstruction utilizing central quadriceps free tendon. Orthop Clin North Am 34:31-39. 2003
  32. Lund B, Nielsen T, Fauno P, et al. Is quadriceps tendon a better graft choice than patellar tendon? A prospective randomized study, Arthroscopy Vol 30 (ePub ahead of print) 2014
  33. Schulz AP, Lange V, Gille J, et al. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months, Open Access Sports Med 4: 243-249, 2013
  34. Maletis G, Inacio M, Reynolds S., et al. Incidence of post-operative anterior cruciate ligament reconstruction infections: Graft choice makes a difference, Am J Sports Med 41, 1780-1785. 2013
  35. Rabuck S, Musahl V, Fu F, West R., Anatomic anterior cruciate ligament reconstruction with quadriceps tendon autograft, Clin Sports Med 32, 155-164. 2013
  36. Adams D.J., Mazzocca A.D., Fulkerson J.P.: Residual strength of the quadriceps versus patellar tendon after harvesting a central free tendon graft. Arthroscopy 22. (1): 76-79.2006
  37. Shoemaker S.C., Adams D., Daniel D.M., et al: Quadriceps/anterior cruciate graft interaction. An in vitro study of joint kinematics and anterior cruciate ligament graft tension. Clin Orthop 294. 379-390.1993
  38. Gianotti S, Marshall S, Hume P, Bunt L, Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population based study, J Sci Med Sport 12: 622-627. 2009
  39. Persson A, Fjeldsgaard K, Gjertsen J, et al, Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction; a study of 12,643 patients from the Norweigian cruciate ligament registry, 2004-2012, Am J Sports Med 42; 285-291. 2013
  40. Maletis G, Inacio M, Desmond J, Funahashi T, Reconstruction of the anterior cruciate ligament; association of graft choice with increased risk of early revision, The Bone & Joint Journal 95-B 623-628. 2013

All Services and Treatments


Dr HC Chang

  • 16 years of experience in surgical and non-surgical procedures in sports injuries as a Sports Orthopaedic Specialist in Singapore.
  • Received multiple awards and accolades in the Orthopaedic field.
  • He is a USA Sports Medicine Fellowship trained Orthopaedic Surgeon and is a member of the Arthroscopy Association of North America as well as the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine.
  • Published many acclaimed articles on Sports Medicine. If you are experiencing one or more of the symptoms mentioned above, it is important to get a prompt and accurate diagnosis to determine the severity of your injury and get proper treatment immediately.


Get in Touch

(65) 6836 6636


Get Appointment

Fast Enquiry
close slider

    Consult Us Today

    First Consultation $150 (before GST) | Subsequent Consultation $90 (before GST)
    *Medications, Investigations & Treatments are charged separately.