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. 2025 Feb 18;13(2):23259671251318014.
doi: 10.1177/23259671251318014. eCollection 2025 Feb.

Smaller Width Quadriceps Tendon Grafts Maintain Advantageous Biomechanical Properties for ACL Reconstruction

Richard C Lee  1 , Steven D Voinier  2   3 , Conor F McCarthy  1 , Donald F Colantonio  4 , Shawn M Gee  4 , Christopher J Tucker  1 , Melvin D Helgeson  1 , Nicholas P Lopreiato  1
Affiliations

Smaller Width Quadriceps Tendon Grafts Maintain Advantageous Biomechanical Properties for ACL Reconstruction

Richard C Lee et al. Orthop J Sports Med. .

Abstract

Background: Despite clinical evidence of risks in knee arthrofibrosis and graft impingement with larger grafts, the optimal size for quadriceps tendon (QT) autografts in anterior cruciate ligament reconstruction (ACLR) has not been established.

Purpose/hypothesis: This study aimed to evaluate the mechanical properties of full-thickness 6-mm and 8-mm wide QT grafts compared with 10-mm patellar tendon (PT) and 10-mm QT grafts. The hypothesis was that both the 6- and 8-mm QT grafts would exhibit similar or superior ultimate tensile strength compared with the 10-mm PT graft.

Study design: Controlled laboratory study.

Methods: A total of 18 matched pairs of cadaveric knees were used in this study. From each pair, a 10-mm wide full-thickness QT was harvested from 1 knee. Based on randomization, a 6-mm wide or 8-mm wide full-thickness QT along with a 10-mm wide PT were harvested from the contralateral knee. Each tendon was clamped, tensioned, and cycled on a servohydraulic testing machine before final loading to failure.

Results: The ultimate failure load was 1286 ± 237.3 N for the 10-mm QT, 1056 ± 226.7 N for the 8-mm QT, 935.1 ± 283.8 N for the 6-mm QT, and 816 ± 192.7 N for the 10-mm PT. Ultimate tensile strength differed significantly between the 10-mm and 8-mm QT (P = .004), 10-mm and 6-mm QT (P < .001), 10-mm QT and 10-mm PT (P < .001), and 8-mm QT and 10-mm PT grafts (P < .001), but not between the 6-mm QT and 10-mm PT grafts (P = .152).

Conclusion: The 8-mm QT had higher ultimate tensile strength than the 10-mm PT, and the 6-mm QT was comparable to the 10-mm PT. Full-thickness QT grafts <10 mm in width may maintain sufficient tensile strength for ACLR.

Clinical relevance: Given these biomechanical properties, smaller QT graft sizes may be advantageous in minimizing arthrofibrosis risk while maintaining graft strength.

Keywords: anterior cruciate ligament reconstruction; biomechanics; quadriceps tendon graft.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This research was supported in part by an appointment to the Department of Defense (DoD) Research Participation Program administered by the Oak Ridge Institute for Science and Education (ORISE) through an interagency agreement between the United States Department of Energy (DoE) and the DoD. The ORISE is managed by Oak Ridge Associated Universities under DoE contract number DESC00114664. Funding was also received for acquiring cadaveric specimens through a Society of Military Orthopaedic Surgeons: Military Orthopaedics and Readiness Optimization Research Grant. C.F.M. has received education payments from Supreme Orthopedic Systems and hospitality payments from Stryker. S.M.G. has received grant support from Arthrex and education payments from Supreme Orthopedic Systems and SeaPearl. C.J.T. has received education payments from Arthrex. N.P.L. has received education payments from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Walter Reed National Military Medical Center (protocol No. WRNMMC-EDO-2022-0994).

Figures

Figure 1.
Figure 1.
Harvested (A) 10-mm QT, (B) 6-mm QT, and (C) 10-mm PT grafts from a single cadaveric specimen. PT, patellar tendon; QT, quadriceps tendon.
Figure 2.
Figure 2.
(A) Tendon clamp configuration and (B) midsubstance/shear-type failure of a quadriceps tendon. For orientation: l = length, t = thickness; w = width.
Figure 3.
Figure 3.
Mechanical properties and statistical significance (P < .05) according to tendon group. The dashed line indicates significant differences compared with the 10-mm PT; the solid line indicates significant differences compared with the 10-mm QT; the asterisk indicates a significant difference between the 10-mm QT and the 10-mm PT. PT, patellar tendon; QT, quadriceps tendon.
See this image and copyright information in PMC

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