Open Full-Thickness Quadriceps Tendon Autograft Harvest With Repair for Anterior Cruciate Ligament Reconstruction

Abstract

Historically, one of the most common graft choices for anterior cruciate ligament (ACL) reconstruction in the pediatric population has been the hamstring autograft. Although pediatric ACL reconstructions with a hamstring autograft have allowed a majority of children and adolescents to return to athletics, it has been reported that anywhere between 6% and 38% of these patients will go on to experience subsequent graft rupture. The quadriceps tendon autograft is an alternative to the hamstring tendon autograft that demonstrates superior preliminary outcomes, and we currently recommend it for skeletally immature patients undergoing primary and revision ACL reconstruction. This paper aims to describe our technique for an open full-thickness quadriceps tendon harvest with repair.

Fig 1

Lateral view of the right knee. A 5-cm incision is shown over the quadriceps tendon extending to the superior pole of the patella.

Fig 2

Right knee. Central portion of the quadriceps tendon marked with a surgical pen to the superior pole of the patella.

Fig 3

Right knee. Double-bladed scalpel is used to incise the central portion of the quadriceps tendon straddling the previously placed markings.

Fig 4

Right knee. The quadriceps tendon is freed from remaining surrounding tissue attachments with a #15 blade.

Fig 5

Right knee. Once proper length is obtained, the proximal end of the graft is amputated with a #15 blade.

Fig 6

Harvested 73-mm quadriceps tendon autograft for use in complete transphyseal anterior cruciate ligament reconstruction.

Fig 7

Right knee. View of the quadriceps tendon defect after completion of full-thickness graft harvest.

Fig 8

Right knee. Repair of the remaining quadriceps defect using #2 ETHIBOND sutures in an interrupted simple fashion.

Fig 9

Lateral view of the right knee. Finished quadriceps tendon repair extending to the superior pole of the patella.

Fig 10

Quadriceps tendon autograft prepared with a modified Krakow technique and BTB TightRopes on both the femoral and tibial ends.

Fig 11

One-year postoperative sagittal magnetic resonance imaging of the right knee after all epiphyseal anterior cruciate ligament reconstruction with a quadriceps tendon autograft (white circle).