Quad Graft ACL Pros and Cons

Reconstruction of the anterior cruciate ligament (ACL) with a quadriceps tendon autograft is a surgical procedure that uses a portion of your own quadriceps tendon to replace or reconstruct a ruptured ACL ligament in your knee. The quadriceps tendon is a thick band of tissue that runs above the patella, or kneecap.

The ideal tendon for an autograft of the anterior cruciate ligament (ACL) is still debatable. Some studies show that the patellar tendon can be used, especially in young athletes and people who have a lot of laxities. 

More attention should be paid to the quadriceps tendon. While the quadriceps tendon is a robust tendon and an excellent donor for an ACL autograft, it has not been used or studied as extensively as other graft sources. Only 2.5 percent of ACL repairs performed in 2010 used the quad tendon. By 2014, that figure had risen to 11%, according to a study published in Knee Surgery, Sports Traumatology, and Arthroscopy. According to an informal survey of surgeons at a recent national convention, quad graft utilization in primary ACL restorations may be closer to 20%.

In comparison to patellar tendons, quad tendons provide a stronger graft with superior tensile qualities, including the following:

• Increased collagen and fibroblast density.
• Strong remaining tendon after harvest.

In addition, quad tendon reconstruction has been shown to have less pain and numbness in the front of the knee at 55-month follow-up but has the same stability and function as patellar tendon reconstruction.

All patients can benefit from quad tendon autografts. Graft selection should be based on imaging and a discussion of the patient's objectives and concerns. Any history of tendinitis or tendonosis in a potential graft tissue should be enough to rule it out as a graft candidate.

The quadriceps tendon–patellar bone graft (QTB graft) causes less kneeling pain, graft site pain, and sensitivity loss than the Bone-Patellar Tendon-Bone Graft (BPTB graft); however, the anterior knee stability and subjective outcomes are equivalent. According to the findings of this study, QTB is a promising choice for ACL reconstruction.

Quad Graft ACL Pros

• Clinical outcomes with this graft have been favorable. Prospective data on nearly 1,000 grafts indicate a 4.2 percent failure rate, with a mean patient age of 20 years. Thus, for future athletes, the all-soft tissue quadriceps graft will be the surgical option for ACL restoration.
• The quadriceps tendon–patellar bone graft (QTB graft) results in less kneeling pain, low-intensity graft site pain, and minimal loss of sensitivity than the Bone-Patellar Tendon-Bone Graft (BPTB graft); although, anterior knee stability and subjective outcomes are identical. 
• QTB appears to be a promising option for ACL reconstruction, according to the findings of a few studies.
• Furthermore, at a 55-month follow-up, quad tendon repair was found to have reduced pain and numbness in the front of the knee while maintaining the same stability and function as patellar tendon restoration.

Quad Graft ACL Cons

The biggest downside of quad tendon harvest is delayed quad activity for the first several months due to harvesting discomfort/quad inhibition. This is still faster than harvesting patella tendon, but slower than the hamstring.