Is Quadriceps Tendon a Better Graft Choice Than Patellar Tendon? A Prospective Randomized Study

Lund, Bent; Nielsen, Torsten Grønbech; Faunø, Peter; Christiansen, Sofus; Lind, Martin

doi:10.1016/j.arthro.2014.01.012

Cited by 158 publications

(195 citation statements)

References 21 publications

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“…1 Among the proposed advantages are low morbidity at the harvest site [2][3][4] ; predictable size and great versatility; and the ability to harvest grafts in different widths, thicknesses, and lengths.…”

mentioning

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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mentioning

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 often-overlooked third autograft option is becoming increasingly popular. Lund et al investigated quadriceps tendonbone and bone-patellar tendon-bone grafts and reported fewer positive pivot shifts (14% compared with 38%) and fewer occurrences of anterior knee pain (7% compared with 34%) for the quadriceps tendon-bone cohort 40 . Contralateral autograft harvest remains a viable option, and a recent Level-I study identified no benefits or drawbacks with contralateral hamstring autograft tendon harvest 41 .…”

Section: Acl Graftmentioning

confidence: 98%

What’s New in Sports Medicine

Tanksley

Werner

et al. 2015

The Journal of Bone and Joint Surgery

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“…Historically, hamstrings and the central-third of patellar tendon (PT) have been considered to be the gold standard for ACL reconstruction over the last decades. Even if quadriceps tendon (QT) autograft has not gained widespread use like other autograft options, recently it has gained popularity [7][8][9][10] . In fact, several Authors supported its use because of a good biomechanical behavior of the QT graft 9,11-13 .…”

Section: Introductionmentioning

confidence: 99%

MRI evaluation to predict tendon size for knee ligament reconstruction

Grassedonio

Albano

Galia

et al. 2017

MLTJ

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SummaryBackground: The aim of this study is to evaluate a possible correlation between specific anthropometric parameters and sizes of knee tendons commonly used for ACL reconstruction. We hypothesized that specific clinical and radiological knee measurements could be better tendon sizes predictors than age, gender, height and weight. Materials and methods: 100 consecutive patients were enrolled and 77 patients met the inclusion criteria of the study. All patients underwent a MRI of the knee with a 1.5 T super conducting MR System. For each patient, anthropometric data such as gender, height, weight, body mass index (BMI) and knee circumference were recorded. Specific MRI knee measurements were performed on each study: patellar tendon (PT) thickness and length, quadriceps tendon (QT) thickness, semitendinosus tendon (ST) diameter, gracilis tendon (GR) diameter, the largest patella and intercondylar width. Results: The mean ST diameter, QT thickness and PT thickness were higher in males than in females. No significant differences were noted between males and females concerning GT diameter and the knee circumference. In addition, male knees had greater patellar and intercondylar width than female knees. Significant, but only weak correlations were found between patient anthropometric data and hamstrings diameter, PT length, and QT and PT thickness. Intercondylar and patellar width present a moderate correlation between PT thickness, PT length and ST diameter. Conclusion:The intercondylar and patellar width presented a moderate correlation with PT thickness, PT length and ST diameter. Further, weak correlations were found between patient anthropometric data (gender, weight, height, BMI) and GR and ST diameter, PT length, and QT and PT thickness. This results may help surgeons during preoperative planning, specifically regarding graft choice and size. Level of evidence: III.

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Is Quadriceps Tendon a Better Graft Choice Than Patellar Tendon? A Prospective Randomized Study

Cited by 158 publications

References 21 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

What’s New in Sports Medicine

MRI evaluation to predict tendon size for knee ligament reconstruction

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