Quadriceps tendon anterior cruciate ligament reconstruction
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Quadriceps tendon anterior cruciate ligament reconstruction Theresa Diermeier1,2 · Rob Tisherman1,2 · Jonathan Hughes1 · Michael Tulman3 · Erica Baum Coffey4 · Christian Fink5,6 · Andrew Lynch3,4 · Freddie H. Fu1 · Volker Musahl1 Received: 24 October 2019 / Accepted: 3 February 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Quadriceps tendon is a promising alternative graft option for anterior cruciate ligament (ACL) reconstruction, which can be harvested with or without a bone block as well as a full or partial thickness graft. Therefore, quadriceps tendon graft could be used in primary and revision ACL reconstruction based on the requirements (tunnel size, tunnel position, etc.). The all soft tissue, partial thickness quadriceps tendon graft in detail and pitfalls of the harvest are described in the present review. After quadriceps tendon harvest, especially in soccer players, who need a strong quadriceps to strike a ball with power, the postoperative rehabilitation may need to be adapted. Level of evidence V. Keywords Anterior cruciate ligament (ACL) · Reconstruction · Graft · Quadriceps tendon
Introduction Over the last 20 years, the technique for anterior cruciate ligament (ACL) reconstruction has changed from transtibial reconstruction to a reconstruction respecting anatomic principles and technique [29]. Currently, anatomical single bundle ACL reconstruction is the gold standard for restoration of anterior tibial translation and rotatory knee stability [19, 70]. Nevertheless, there remains debate over ideal graft choice [33]. Bone-patella tendon-bone (BPTB) graft is viewed by many as the gold standard graft [8], but may be associated with postoperative anterior knee pain [21, 23], kneeling pain [11], and an increased risk for development of * Volker Musahl [email protected] 1
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA 15203, USA
2
Department of Orthopaedic Sport Medicine, Technical University Munich, Munich, Germany
3
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
4
UPMC Centers for Rehab Services, Pittsburgh, PA, USA
5
Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
6
Research Unit for Orthopedic Sports Medicine and Injury Prevention, UMIT Hall, Hall, Austria
patellofemoral osteoarthritis (OA) [22, 49, 53]. Hamstring tendons (HT) (semitendinosus and gracilis) are less predictable in size and weaken knee flexion [58]. Although no difference in clinical outcome between BPTB and HT has been demonstrated, ACL reconstruction with HT fails at a higher rate than BPTB, especially in young athletes [57]. Overall, the failure rate for primary ACL reconstruction is under 5% [34, 64], but the failure rate for young active males with HT ACL reconstruction is reported to be as high as 28% [67]. Allografts might be another source, but are associated with increased cost and have demonstrated a more than 1
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