The Anterior Approach
“The Quadriceps Tendon Deserves More Consideration as a Primary Option for Graft Choice in ACL Reconstruction”
Controversy still remains for optimal graft choice in an anterior cruciate ligament (ACL) reconstruction. Results from the Multicenter Orthopaedic Outcomes Network (MOON) support use of the patellar tendon, especially in young athletes and patients with high-grade laxity. The hamstring tendon is another popular option, although some studies show possible inferior outcomes when compared to patellar tendon in young athletes.
But San Francisco Orthopaedic Specialists surgeon and sports medicine expert Edward Shin, MD, says the quadriceps tendon deserves more consideration as a primary option for graft choice in ACL reconstruction.
While a robust tendon — a good source for an ACL autograft — the quadriceps tendon is now being used more frequently due to its favorable biomechanical properties and clinical outcomes. This is supported by studies of quad tendon reconstruction, which have reported less anterior knee pain and numbness at 55-month follow-up, but equivalent stability and functional outcomes compared to patellar tendon reconstruction.
“The quad tendon’s popularity for use in ACL reconstruction is increasing. I decided to use the technique in 2018 after studies started to show excellent mid term outcomes in comparison to patellar tendons. As one of the first surgeons to employ this technique in the San Francisco Bay Area, I have seen excellent results and I certainly advocate for its use over hamstring autograft and allograft (cadaver graft) in the correct patients. The patients who we used quadriceps tendon for ACL reconstruction had less postop pain, less longer term anterior knee pain and less numbness. They were recovering faster and moving their knees earlier, which is important for an active population.”
More Favorable Tensile Properties
Compared to patellar tendons, quad tendons offer a thicker graft with more favorable tensile properties, including:
Strong, Reliable and Readily Available
Over the last five to 10 years, surgical instrumentation has made harvesting tendon autografts easier and more precise.“We’re getting precise and accurate sizes and quality length, and we have good devices to fixate and suspend the graft in place while it heals into or around the bone tunnels,” says Dr. Shin. “Quad tendon grafts are strong, reliable, readily available and significantly thicker and more robust than the patellar tendon. Use of quad tendon in ACL reconstruction has led to lower complication rates, equivalent outcomes to patellar tendon (our traditional gold standard) and as an added bonus, the tendon can be harvested through a small 2 cm incision providing a more pleasing aesthetic result after surgery.”