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

Abstract

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

Lymphocyte and Neutrophil to Lymphocyte Ratio do not Predict Mortality in Hip Fracture Patients

“…Fracture type, timing of surgery, technique and implant may also ultimately influence outcome but current results are inconsistent [18][19][20]22].…”

Primary Anterior Cruciate Ligament Reconstruction. How Do We Do It?

“…10 Among the proposed advantages there are low morbidity at the harvest site, predictable size and great versatility, being able to be harvested in various widths, thicknesses, and lengths. [11][12][13][14][15] sUrGICAL TEChNIqUE…”

“…With the use of a free quadriceps graft, the method of femoral fixation with suspensory button was previously described by us. 15…”

Double whip stitch for free graft femoral fixation in ACL reconstruction: experimental study on porcine model

“…However, harvesting a quadriceps tendon with a patellar bone plug can be associated with chronic anterior knee pain resulting in less satisfactory clinical outcome [ 3 ]. The use of a free quadriceps tendon harvested from the median portion with a clean cut at the superior patellar pole has even less donor site morbidity, with a satisfactory length and width for an ACL reconstruction graft [ 4 , 5 ]. However, as long as the tibial tunnel fixation with interference screws is considered the standard fixation, femoral fixation is still an open subject.…”