A Prospective Observational Study on Quadriceps Tendon as a Graft for Anterior Cruciate Ligament Reconstruction: Surgical Technique and Graft Dimensions
-
Mahesh B Shinde
,
Mihir R Patel
,
Bibhas DasGupta
,
Atharva Sharma
,
Kshitij Sarwey
,
Sanket Jethliya
,
Shreyas Revankar
,
Deepanshu Garg
,
Rohan Bahl
,
Samreen Chunawala
,
Sidharth Mitra
,
Juily Satam
,
Yash Nav Singh
,
Kiara Thakur
Abstract
Background: The quadriceps tendon (QT) graft provides better biomechanical strength, less donor site morbidity, and adjustable size, despite the fact that hamstring and bone-patellar tendon-bone (BPTB) grafts are frequently utilized. Recent research indicates similar results of other grafts, despite early reservations. In order to validate the QT graft's efficacy and dependability in clinical settings, this study will detail the surgical procedure for anterior cruciate ligament (ACL) repair and evaluate its three main dimensions: length, diameter, and thickness.
Methods: Fifty patients with ACL injuries who received QT transplants participated in this 24-month prospective research. Patients with isolated ACL injuries and a normal body mass index (BMI) between the ages of 20 and 50 were eligible. Grafts were harvested, processed, and their thickness, diameter, and length were measured. Suspensory fixation was done and anatomical tunnels were made. The following day, rehabilitation got underway. A proforma was used to collect and analyze the data. Informed consent and institutional ethics approval were acquired.
Results: In a study of 50 patients with ACL restoration, 84% had QT grafts of appropriate length (mean: 28.7 cm), while 70% had sufficient quadrupled lengths (mean: 7 cm). The majority of grafts’ diameter (96%, mean: 8.6 mm) and thickness (94%, mean: 6.8 mm) fell within the acceptable parameters. These findings show that QT grafts consistently produced adequate dimensions for ACL restoration, demonstrating their dependability and efficacy.
Conclusion: The QT graft offers a consistent, adequate tissue source for ACL reconstruction, ideal for active patients needing strong, durable grafts.
1. Mancino F, Kayani B, Gabr A, Fontalis A, Plastow R, Haddad FS. Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention. Bone Jt Open. 2024;5(2):94-100. doi: 10.1302/2633-1462.52.Bjo-2023-0166. [PubMed: 38310925]. [PubMed Central: PMC10838619].
2. Itthipanichpong T, Tangboonnitiwong N, Limskul D, Tanpowpong T, Kuptniratsaikul S, Thamrongskulsiri N.
Arthroscopic Anterior Cruciate Ligament Primary Repair With Synthetic Augmentation and Fixation With the Knotless Suture Anchor. Arthrosc Tech. 2023;12(7):e1009-e13. doi: 10.1016/j.eats.2023.02.040. [PubMed:37533897]. [PubMed Central: PMC10390709].
3. Rathore S, Suri H, Quadri V, Gollamudi S. Arthroscopic ACL reconstruction with aperture interference fixation: Graft comparison, BPTB versus hamstring tendon- Cohort study with two year follow-up. J Med Sci Res. 2017;5(1):5-12. doi: 10.17727/JMSR.2017/5-2.
4. Dhammi IK, Rehan Ul H, Kumar S. Graft choices for anterior cruciate ligament reconstruction. Indian J Orthop.
2015;49(2):127-8. doi: 10.4103/0019-5413.152393. 26015598]. [PubMed Central: PMC4436475].
5. Migliorini F, Torsiello E, Trivellas A, Eschweiler J, Hildebrand F, Maffulli N. Bone-patellar tendon-bone versus two- and fourstrand hamstring tendon autografts for ACL reconstruction in young adults: a Bayesian network meta-analysis. Sci Rep. 2023;13(1):6883. doi: 10.1038/s41598-023-33899-1. [PubMed: 37106008]. [PubMed Central: PMC10140035].
6. Mohtadi NG, Chan DS, Dainty KN, Whelan DB. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2011;2011(9):Cd005960. doi: 10.1002/14651858.CD005960.pub2. [PubMed: 21901700]. [PubMed Central: PMC6465162].
7. Flaherty A, Escalera C, Haeberle H, Fealy S, Lee SK. Injury to the Main Branch of the Saphenous Nerve following Hamstring Tendon Graft Harvesting: A Report of 3 Cases. Hss J. 2025;21(1):107-12. doi: 10.1177/15563316241230285. [PubMed: 39564412]. [PubMed Central: PMC11572331].
8. Ostojic M, Indelli PF, Lovrekovic B, Volcarenghi J, Juric D, Hakam HT, et al. Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends. Medicina (Kaunas).
2024;60(12):2090. 10.3390/medicina60122090. [PubMed: 39768969]. [PubMed Central: PMC11678177].
9. Clinger B, Xerogeanes J, Feller J, Fink C, Runer A, Richter D, et al. Quadriceps tendon autograft for anterior cruciate ligament reconstruction: state of the art. J Isakos. 2022;7(6): 162-72. doi: 10.1016/j.jisako.2022.08.010. [PubMed: 36096362].
10. Cohen D, Slawaska-Eng D, Almasri M, Sheean A, de Sa D. Quadricep ACL Reconstruction Techniques and Outcomes: an Updated Scoping Review of the Quadricep Tendon. Curr Rev Musculoskelet Med. 2021;14(6):462-74. doi: 10.1007/s12178-02109726-3. [PubMed: 34755275]. [PubMed Central: PMC8733128].
11. Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, et al. Current trends in graft choice for anterior cruciate ligament reconstruction - part I: anatomy, biomechanics, graft incorporation and fixation. J Exp Orthop. 2023;10(1):37. doi: 10.1186/s40634-023-00600-4. [PubMed: 37005974]. [PubMed Central: PMC10067784].
12. Raman R, Mishra BN, Sen A. A Minimally Invasive and Simple Technique of Superficial Quadriceps Tendon Graft Harvesting. Arthrosc Tech. 10.1016/j.eats.2022.08.041. 90 2022;11(12):e2347-e55. [PubMed: 36632391]. [PubMed Central: PMC9827123].
13. Haybäck G, Raas C, Rosenberger R. Failure rates of common grafts used in ACL reconstructions: a systematic review of studies published in the last decade. Arch Orthop Trauma Surg. 2022;142(11):3293-9. doi: 10.1007/s00402-021-04147-w. [PubMed: 34536121]. [PubMed Central: PMC9522752].
14. Marcaccio SE, Morrissey PJ, Testa EJ, Fadale PD. Role of Quadriceps Tendon Autograft in Primary and Revision Anterior Cruciate Ligament Reconstruction. JBJS Rev. 2023;11(10):e23.00057. doi: 10.2106/jbjs.Rvw.23.00057. [PubMed: 37812667]. [PubMed Central: PMC10558152].
15. Mouarbes D, Dagneaux L, Olivier M, Lavoue V, Peque E, Berard E, et al. Lower donor-site morbidity using QT autografts for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2020;28(8):2558-66. doi: 10.1007/s00167-020-05873-1. [PubMed: 32020251].
16. Zhang XF, Liu P, Huang JW, He YH. Efficacy and safety of quadriceps tendon autograft versus bone-patellar tendonbone and hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and metaanalysis. J Orthop Traumatol. 2024;25(1):65. doi: 10.1186/s10195024-00801-2. [PubMed: PMC11656020]. 39694948]. [PubMed Central:
17. Johnson JL, Capin JJ, Arundale AJH, Zarzycki R, Smith AH, Snyder-Mackler L. A Secondary Injury Prevention Program May Decrease Contralateral Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Injury Rates in the ACL-SPORTS Randomized Controlled Trial. J Orthop Sports Phys Ther. 2020;50(9):523-30. doi: 10.2519/jospt.2020.9407. [PubMed: 32741328]. [PubMed Central: PMC7484246].
18. Gong X, Pan JC, Zhang YN. Letter regarding article by Li et al.: Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis. Int Orthop. 2013;37(10):2101. doi: 10.1007/s00264-013-2051-x. [PubMed: 23925883]. [PubMed Central: PMC3779565].
19. Tayeb AM, Almohammadi AA, Hegaze AH, Roublah F, Althakafi KA. Anterior Cruciate Ligament Injury in Association with Other Knee Injuries in King Abdulaziz University Hospital, Saudi Arabia. Cureus. 2020;12(9):e10240. doi: 10.7759/cureus.10240. [PubMed: 33042680]. [PubMed Central: PMC7535945].
20. Krüger-Franke M, Reinmuth S, Kugler A, Rosemeyer B. [Concomitant injuries with anterior cruciate ligament rupture. A retrospective study]. Unfallchirurg. 1995;98(6): 328-32. [PubMed: 7644918].
21. Krebs N, Yaish A, O'Neill N. Anatomic Evaluation of the Quadriceps Tendon in Cadaveric Specimens: Application for Anterior Cruciate Ligament Reconstruction Graft Choice. Spartan Med Res J. 2019;4(1):7961. doi: 10.51894/001c.7961. [PubMed: 33655157]. [PubMed Central: PMC7746052].
22. Dworsky-Fried J, Hadwen A, Bernardini L, Vivekanantha P, Grassi A, Ollivier M, et al. Quadriceps tendon autograft diameters are routinely above 8 mm, and preoperative size estimation before anterior cruciate ligament reconstruction may not be necessary for this graft type: A systematic review. Knee Surg Sports Traumatol Arthrosc. 2025;33(9):3111-33. doi: 10.1002/ksa.12558. [PubMed: 39686764]. [PubMed Central: PMC12392381].
23. Xerogeanes JW. Quadriceps Tendon Graft for Anterior Cruciate Ligament Reconstruction: THE GRAFT OF THE FUTURE! Arthroscopy. 2019;35(3):696-7. doi: 10.1016/j.arthro.2019.01.011. [PubMed: 30827423].
24. Lee RC, Voinier SD, McCarthy CF, Colantonio DF, Gee SM, Tucker CJ, et al. Smaller Width Quadriceps Tendon Grafts Maintain Advantageous Biomechanical Properties for ACL Reconstruction. Orthop J Sports Med. 2025;13(2):23259671251318014. doi: 10.1177/23259671251318014. [PubMed: 39968412]. [PubMed Central: PMC11833892].
2. Itthipanichpong T, Tangboonnitiwong N, Limskul D, Tanpowpong T, Kuptniratsaikul S, Thamrongskulsiri N.
Arthroscopic Anterior Cruciate Ligament Primary Repair With Synthetic Augmentation and Fixation With the Knotless Suture Anchor. Arthrosc Tech. 2023;12(7):e1009-e13. doi: 10.1016/j.eats.2023.02.040. [PubMed:37533897]. [PubMed Central: PMC10390709].
3. Rathore S, Suri H, Quadri V, Gollamudi S. Arthroscopic ACL reconstruction with aperture interference fixation: Graft comparison, BPTB versus hamstring tendon- Cohort study with two year follow-up. J Med Sci Res. 2017;5(1):5-12. doi: 10.17727/JMSR.2017/5-2.
4. Dhammi IK, Rehan Ul H, Kumar S. Graft choices for anterior cruciate ligament reconstruction. Indian J Orthop.
2015;49(2):127-8. doi: 10.4103/0019-5413.152393. 26015598]. [PubMed Central: PMC4436475].
5. Migliorini F, Torsiello E, Trivellas A, Eschweiler J, Hildebrand F, Maffulli N. Bone-patellar tendon-bone versus two- and fourstrand hamstring tendon autografts for ACL reconstruction in young adults: a Bayesian network meta-analysis. Sci Rep. 2023;13(1):6883. doi: 10.1038/s41598-023-33899-1. [PubMed: 37106008]. [PubMed Central: PMC10140035].
6. Mohtadi NG, Chan DS, Dainty KN, Whelan DB. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2011;2011(9):Cd005960. doi: 10.1002/14651858.CD005960.pub2. [PubMed: 21901700]. [PubMed Central: PMC6465162].
7. Flaherty A, Escalera C, Haeberle H, Fealy S, Lee SK. Injury to the Main Branch of the Saphenous Nerve following Hamstring Tendon Graft Harvesting: A Report of 3 Cases. Hss J. 2025;21(1):107-12. doi: 10.1177/15563316241230285. [PubMed: 39564412]. [PubMed Central: PMC11572331].
8. Ostojic M, Indelli PF, Lovrekovic B, Volcarenghi J, Juric D, Hakam HT, et al. Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends. Medicina (Kaunas).
2024;60(12):2090. 10.3390/medicina60122090. [PubMed: 39768969]. [PubMed Central: PMC11678177].
9. Clinger B, Xerogeanes J, Feller J, Fink C, Runer A, Richter D, et al. Quadriceps tendon autograft for anterior cruciate ligament reconstruction: state of the art. J Isakos. 2022;7(6): 162-72. doi: 10.1016/j.jisako.2022.08.010. [PubMed: 36096362].
10. Cohen D, Slawaska-Eng D, Almasri M, Sheean A, de Sa D. Quadricep ACL Reconstruction Techniques and Outcomes: an Updated Scoping Review of the Quadricep Tendon. Curr Rev Musculoskelet Med. 2021;14(6):462-74. doi: 10.1007/s12178-02109726-3. [PubMed: 34755275]. [PubMed Central: PMC8733128].
11. Runer A, Keeling L, Wagala N, Nugraha H, Özbek EA, Hughes JD, et al. Current trends in graft choice for anterior cruciate ligament reconstruction - part I: anatomy, biomechanics, graft incorporation and fixation. J Exp Orthop. 2023;10(1):37. doi: 10.1186/s40634-023-00600-4. [PubMed: 37005974]. [PubMed Central: PMC10067784].
12. Raman R, Mishra BN, Sen A. A Minimally Invasive and Simple Technique of Superficial Quadriceps Tendon Graft Harvesting. Arthrosc Tech. 10.1016/j.eats.2022.08.041. 90 2022;11(12):e2347-e55. [PubMed: 36632391]. [PubMed Central: PMC9827123].
13. Haybäck G, Raas C, Rosenberger R. Failure rates of common grafts used in ACL reconstructions: a systematic review of studies published in the last decade. Arch Orthop Trauma Surg. 2022;142(11):3293-9. doi: 10.1007/s00402-021-04147-w. [PubMed: 34536121]. [PubMed Central: PMC9522752].
14. Marcaccio SE, Morrissey PJ, Testa EJ, Fadale PD. Role of Quadriceps Tendon Autograft in Primary and Revision Anterior Cruciate Ligament Reconstruction. JBJS Rev. 2023;11(10):e23.00057. doi: 10.2106/jbjs.Rvw.23.00057. [PubMed: 37812667]. [PubMed Central: PMC10558152].
15. Mouarbes D, Dagneaux L, Olivier M, Lavoue V, Peque E, Berard E, et al. Lower donor-site morbidity using QT autografts for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2020;28(8):2558-66. doi: 10.1007/s00167-020-05873-1. [PubMed: 32020251].
16. Zhang XF, Liu P, Huang JW, He YH. Efficacy and safety of quadriceps tendon autograft versus bone-patellar tendonbone and hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and metaanalysis. J Orthop Traumatol. 2024;25(1):65. doi: 10.1186/s10195024-00801-2. [PubMed: PMC11656020]. 39694948]. [PubMed Central:
17. Johnson JL, Capin JJ, Arundale AJH, Zarzycki R, Smith AH, Snyder-Mackler L. A Secondary Injury Prevention Program May Decrease Contralateral Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Injury Rates in the ACL-SPORTS Randomized Controlled Trial. J Orthop Sports Phys Ther. 2020;50(9):523-30. doi: 10.2519/jospt.2020.9407. [PubMed: 32741328]. [PubMed Central: PMC7484246].
18. Gong X, Pan JC, Zhang YN. Letter regarding article by Li et al.: Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis. Int Orthop. 2013;37(10):2101. doi: 10.1007/s00264-013-2051-x. [PubMed: 23925883]. [PubMed Central: PMC3779565].
19. Tayeb AM, Almohammadi AA, Hegaze AH, Roublah F, Althakafi KA. Anterior Cruciate Ligament Injury in Association with Other Knee Injuries in King Abdulaziz University Hospital, Saudi Arabia. Cureus. 2020;12(9):e10240. doi: 10.7759/cureus.10240. [PubMed: 33042680]. [PubMed Central: PMC7535945].
20. Krüger-Franke M, Reinmuth S, Kugler A, Rosemeyer B. [Concomitant injuries with anterior cruciate ligament rupture. A retrospective study]. Unfallchirurg. 1995;98(6): 328-32. [PubMed: 7644918].
21. Krebs N, Yaish A, O'Neill N. Anatomic Evaluation of the Quadriceps Tendon in Cadaveric Specimens: Application for Anterior Cruciate Ligament Reconstruction Graft Choice. Spartan Med Res J. 2019;4(1):7961. doi: 10.51894/001c.7961. [PubMed: 33655157]. [PubMed Central: PMC7746052].
22. Dworsky-Fried J, Hadwen A, Bernardini L, Vivekanantha P, Grassi A, Ollivier M, et al. Quadriceps tendon autograft diameters are routinely above 8 mm, and preoperative size estimation before anterior cruciate ligament reconstruction may not be necessary for this graft type: A systematic review. Knee Surg Sports Traumatol Arthrosc. 2025;33(9):3111-33. doi: 10.1002/ksa.12558. [PubMed: 39686764]. [PubMed Central: PMC12392381].
23. Xerogeanes JW. Quadriceps Tendon Graft for Anterior Cruciate Ligament Reconstruction: THE GRAFT OF THE FUTURE! Arthroscopy. 2019;35(3):696-7. doi: 10.1016/j.arthro.2019.01.011. [PubMed: 30827423].
24. Lee RC, Voinier SD, McCarthy CF, Colantonio DF, Gee SM, Tucker CJ, et al. Smaller Width Quadriceps Tendon Grafts Maintain Advantageous Biomechanical Properties for ACL Reconstruction. Orthop J Sports Med. 2025;13(2):23259671251318014. doi: 10.1177/23259671251318014. [PubMed: 39968412]. [PubMed Central: PMC11833892].
| Files | ||
| Issue | Vol 12 No 2 (2026) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v12i2.21513 | |
| Keywords | ||
| Arthroscopy Grafts Quadriceps Muscle Semitendinosus Anterior Cruciate Ligament | ||
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How to Cite
1.
Shinde M, Patel M, DasGupta B, Sharma A, Sarwey K, Jethliya S, Revankar S, Garg D, Bahl R, Chunawala S, Mitra S, Satam J, Nav Singh Y, Thakur K. A Prospective Observational Study on Quadriceps Tendon as a Graft for Anterior Cruciate Ligament Reconstruction: Surgical Technique and Graft Dimensions. J Orthop Spine Trauma. 2026;12(2):86-90.
