Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft and press-fit fixation using an anteromedial portal technique

Abstract

BackgroundThis article describes an arthroscopic anterior cruciate ligament (ACL) reconstruction technique with a quadriceps tendon autograft using an anteromedial portal technique.MethodsA 5 cm quadriceps tendon graft is harvested with an adjacent 2 cm bone block. The femoral tunnel is created through a low anteromedial portal in its anatomical position. The tibial tunnel is created with a hollow burr, thus acquiring a free cylindrical bone block. The graft is then passed through the tibial tunnel and the bone block, customized at its tip, is tapped into the femoral tunnel through the anteromedial portal to provide press-fit fixation. The graft is tensioned distally and sutures are tied over a bone bridge at the distal end of the tibial tunnel. From the cylindrical bone block harvested from the tibia the proximal end is customized and gently tapped next to the graft tissue into the tibial tunnel to assure press fitting of the graft in the tibial tunnel. The distal part of the tibial tunnel is filled up with the remaining bone.All patients were observed in a prospective fashion with subjective and objective evaluation after 6 weeks, 6 and 12 months.ResultsThirty patients have been evaluated at a 12 months follow-up. The technique achieved in 96.7% normal or nearly normal results for the objective IKDC. The mean subjective IKDC score was 86.1 ± 15.8. In 96.7% the Tegner score was the same as before injury or decreased one category. A negative or 1+ Lachman test was achieved in all cases. Pivot-shift test was negative or (+) glide in 86.7%. The mean side-to-side difference elevated by instrumental laxity measurement was 1.6 ± 1.1 mm. Full ROM has been achieved in 92.3%. The mean single one-leg-hop index was 91.9 ± 8.0 at the follow-up.ConclusionsPotential advantages include minimum bone loss specifically on the femoral side and graft fixation without implants.

Outcomes Following ACL Reconstruction Utilizing the Quadriceps Tendon Autograft: A Critically Appraised Topic

“…• Four relevant [3][4][5][6] studies met the inclusion criteria and were included (based on levels on levels of evidence, Centre for Evidence Based Medicine, 2009).…”

“…Three Injured knee: of the four studies 3,4,6 reported improvements in outcomes following ACLR using the QTBP graft; one study 5 reported comparable postoperative scores but did not include preoperative values to make direct comparisons.…”

“…9,10 One study included in this CAT used the subjective IKDC and reported that the mean subjective IKDC follow-up score was 86.1 ± 15.8. 3 However, it must be pointed out that presurgery IKDC scores for these patients were not reported to appropriately interpret the postsurgical scores. The Tegner score is a patient-reported outcome that is used to measure a patient's perspective of their activity, and should be employed pre-and post-ACLR to measure activity limitations and participation restrictions.…”

“…The recommendation of Level B was given because consistent Level 2 evidence or higher was found in all four studies [3][4][5][6] included in this critically appraised topic (CAT). 8 …”

Minimally Invasive Harvest of a Quadriceps Tendon Graft With or Without a Bone Block

“…T he quadriceps tendon (QT) as a graft source for anterior cruciate ligament (ACL) [1][2][3][4][5] and posterior cruciate ligament (PCL) 6 reconstruction has recently achieved increased attention. Although many knee surgeons have been using the QT as a graft for ACL revision surgery, 7,8 it has never gained universal acceptance for primary ACL reconstruction.…”