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Comparative Study
. 2014 Mar;42(3):723-30.
doi: 10.1177/0363546513516603. Epub 2014 Jan 8.

Biomechanical evaluation of the quadriceps tendon autograft for anterior cruciate ligament reconstruction: a cadaveric study

Norihiro Sasaki  1 , Kathryn F Farraro, Kwang E Kim, Savio L-Y Woo
Affiliations
Comparative Study

Biomechanical evaluation of the quadriceps tendon autograft for anterior cruciate ligament reconstruction: a cadaveric study

Norihiro Sasaki et al. Am J Sports Med. 2014 Mar.

Abstract

Background: Recently, many surgeons have chosen the quadriceps tendon (QT) as an autograft for anterior cruciate ligament (ACL) reconstruction. However, there have not been biomechanical studies that quantitatively evaluated knee function after reconstruction using a QT autograft.

Purpose: To measure the 6 degrees of freedom knee kinematics and in situ graft forces after reconstruction with a QT autograft compared with a quadrupled semitendinosus and gracilis (QSTG) tendon autograft.

Study design: Controlled laboratory study.

Methods: Ten human cadaveric knees (age, 54-64 years) were tested in 3 conditions: (1) intact, (2) ACL deficient, and (3) after ACL reconstruction using a QT or QSTG autograft. With use of a robotic/universal force-moment sensor testing system, knee kinematics and in situ forces in the ACL and autografts were obtained at 5 knee flexion angles under externally applied loads: (1) 134-N anterior tibial load, (2) 134-N anterior tibial load with 200-N axial compression, and (3) 10-N·m valgus and 5-N·m internal tibial torque.

Results: Under the anterior tibial load, both autografts restored anterior tibial translation to within 2.5 mm of the intact knee and in situ forces to within 20 N of the intact ACL at 15°, 30°, and 60°. Adding compression did not change these findings. With the combined rotatory load, the anterior tibial translation and graft in situ forces were again not significantly different from the intact ACL. There were no significant differences between the grafts under any experimental condition.

Conclusion: Reconstruction of the ACL with a QT autograft restored knee function to similar levels as that reconstructed with a QSTG autograft under loads simulating clinical examinations.

Clinical relevance: The positive biomechanical results of this cadaveric study lend support to the use of a QT autograft for ACL reconstruction, as it could restore knee function immediately after surgery under applied loads that mimic clinical examinations.

Keywords: ACL reconstruction; quadriceps tendon autograft; robotic/UFS testing system.

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Figures

Figure 1
Figure 1
A schematic illustrating a human cadaveric knee joint being tested on the robotic/universal force-moment sensor testing system at preselected angles of knee flexion, providing 5 degrees of freedom joint motion (AP, anterior-posterior; FE, flexion-extension; IE, internal-external; ML, medial-lateral; PD, proximal-distal; VV, varus-valgus) at each prescribed angle of knee flexion.
Figure 2
Figure 2
Mean anterior tibial translation of the intact, anterior cruciate ligament–deficient, and quadriceps tendon (QT)– or quadrupled semitendinosus and gracilis (QSTG)–reconstructed knee joint at 15° and 30° of knee flexion in response to (A) a 134-N anterior tibial load and (B) a 134-N anterior tibial load combined with 200-N axial compression.
Figure 3
Figure 3
Mean in situ force of the intact anterior cruciate ligament, quadriceps tendon (QT) autograft, and quadrupled semitendinosus and gracilis (QSTG) autograft at 15° and 30° of knee flexion in response to a combined 10-N-m valgus and 5-N·m internal tibial torque.
See this image and copyright information in PMC

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