Anatomic and Morphological Evaluation of the Quadriceps Tendon Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Xerogeanes, John W.; Mitchell, Phillip M.; Karasev, Peter; Kolesov, Ivan; Romine, Spencer E.

doi:10.1177/0363546513496626

Cited by 86 publications

(100 citation statements)

References 34 publications

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“…The quadriceps tendon is consistent in size, having the anatomic characteristics to produce a graft whose length and volume are both reproducible and predictable. 11 Using a free boneeharvesting technique eliminates the risk of iatrogenic patellar fracture and has minimal donor-site morbidity. This technique does not require any special instruments and is relatively minimally invasive.…”

Section: Discussionmentioning

confidence: 99%

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction

Todor

Caterev

Nistor

et al. 2016

Arthroscopy Techniques

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The most commonly used autografts for anterior cruciate ligament reconstruction are the boneepatellar tendonebone and hamstring tendons. Each has its advantages and limitations. The boneepatellar tendonebone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.T he most commonly used autografts for anterior cruciate ligament (ACL) reconstruction are the boneepatellar tendonebone and hamstring tendons. Recently, there has been an increase in interest in the quadriceps tendon as an autologous graft option for ACL reconstruction. 1 Among the proposed advantages are low morbidity at the harvest site 2-4 ; predictable size and great versatility; and the ability to harvest grafts in different widths, thicknesses, and lengths. 5 The quadriceps tendon graft can be harvested with 6,7 or without a bone block. 8 To completely avoid possible patellar fracture and reduce morbidity at the harvest site, a free bone plug graft is the solution. We present our preferred method of free quadriceps graft harvest for ACL reconstruction and describe how we use a suspensory fixation device for femoral fixation with this type of graft. The harvest method is based on the technique described by Fulkerson and Langeland, 9 but to our knowledge, the cortical button technique has not been described previously. Surgical TechniqueUnder general or spinal anesthesia, the patient is positioned supine on the operating table and the knee flexed to 90 . The skin incision starts from the proximal pole of the patella and extends proximally, in a longitudinal midline fashion, for about 3.5 to 4 cm (Fig 1). After skin and subcutaneous fat incision, the underlying quadriceps tendon is visualized. Medial dissection is

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Section: Discussionmentioning

confidence: 99%

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction

Todor

Caterev

Nistor

et al. 2016

Arthroscopy Techniques

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“…The quadriceps tendon also produced a graft with almost twice the intra-articular volume of that from the patellar tendon. 15,34,39,46,47 Recent unpublished studies by Xerogeanes et al have shown that a matched-width quadriceps tendon graft had an ultimate load 28% higher than a patellar tendon from the same specimen. The quadriceps tendon also had a Young modulus that was similar to the native ACL, whereas that of the patellar tendon was significantly higher and that of the double-looped semitendinosus/gracilis graft was significantly lower than the native ACL.…”

Section: Discussionmentioning

confidence: 99%

Height, Weight, and Age Predict Quadriceps Tendon Length and Thickness in Skeletally Immature Patients

2015

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“…Ultrasound measurements of skeletally immature patients reveals predictable increases in QT thickness relative to age, height and weight 16. Moreover, a separate analysis showed height to be the most important predictor of length of the tendinous portion of the QT graft among a cohort of patients, 34.9±12.6 years of age (range: 17–60 years) 15. These relationships can be used preoperatively to verify that the harvested autograft will be of sufficient diameter and length to accommodate ligamentous reconstructions.…”

Section: New Information On Anatomymentioning

confidence: 97%

“…The width of the tendon ranges between 2.5 and 3 cm, with the greatest width found approximately 3 cm proximal to the tendon’s insertion on the patella 13–15. Additionally, the thickness of the QT is greatest at its distal insertion on the patella, measuring 18±3 mm in males and 16±2 mm in females 15. The tendon’s thickness remains relatively constant throughout the distal 6 cm, measuring 7.4 mm, 7.4 mm and 7.1 mm at 10, 30 and 60 mm proximal to its distal insertion 15…”

Section: New Information On Anatomymentioning

confidence: 98%

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

et al. 2018

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Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium.

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Anatomic and Morphological Evaluation of the Quadriceps Tendon Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Abstract: The quadriceps tendon has the anatomic characteristics to produce a graft whose length and volume are both reproducible and predictable, while yielding a graft with a significantly greater intra-articular volume than a patellar tendon graft with a similar width.

Cited by 86 publications

References 34 publications

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction

Height, Weight, and Age Predict Quadriceps Tendon Length and Thickness in Skeletally Immature Patients

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

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