Minimally Invasive Harvest of a Quadriceps Tendon Graft With or Without a Bone Block

Fink, Christian; Herbort, Mirco; Abermann, Elisabeth; Hoser, Christian

doi:10.1016/j.eats.2014.06.003

Cited by 69 publications

(68 citation statements)

References 19 publications

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“…Using a 2–3 cm transverse incision centred over the superior pole of the patella, Fink et al have described a minimally invasive harvest technique using a double knife 8–12 mm in width (Karl Storz, Tuttlingen, Germany) and a series of specialised tendon separator and cutter (Karl Storz) to truncate the autograft proximally18 (figure 2). Slone et al have described a similar minimally invasive soft tissue-only harvest technique using a 1.5–2 cm longitudinal incision extending proximally from the superior pole of the patella, just lateral to its midpoint 19.…”

Section: New Information On Anatomymentioning

confidence: 99%

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

et al. 2018

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Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium.

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Section: New Information On Anatomymentioning

confidence: 99%

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

et al. 2018

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“…Thus, it is feasible to make an individual graft choice -for instance, to avoid BPTB grafts when anterior knee pain is at risk (floor tiler) or to avoid semitendinosus grafts when concomitant medial collateral ligament injury exists. Novel minimally invasive surgical harvesting techniques for quadriceps tendons promise less cosmetic burden and more clinical acceptance [77] . In a systematic review of overlapping meta-analyses, Mascarenhas et al [78] concluded that allografts were equal to autografts in terms of rerupture rates and clinical outcomes.…”

Section: Graft Choice and Graft Fixationmentioning

confidence: 99%

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

Domnick

Raschke

Herbort

2016

WJO

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ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. Conflict-of-interest statement:There are no conflicts of interest to declare. Open-Access:This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ [1] . The ACL is a central ligament of the knee. The main functional role of the ACL is to provide stability against anterior tibial translation (ATT) and internal rotation. An acute ACL rupture is a common orthopedic trauma, with an estimated incidence of 78 per 100000 persons and a mean age of 32 years in Sweden and an estimated incidence of up to 84 per 100000 persons in the United States [2,3] . A common and frequent injury mechanism is noncontact combined valgus-and internal-rotation trauma [2,4] . Therefore, ACL injuries are often associated with other ligamentous injuries, such as a (partial) rupture of the medial collateral ligament (MCL) or the menisci. In addition, compression of the lateral condyle with a bone bruise or chondral lesion is often associated with the injury due to the valgus trauma. Persistent instability of the knee may be associated with long-term degenerative lesions. Surgical treatment of the ACL in the context of other injured structures and reconstruction of the intact joint kinematics are suggested to be the keys to a good clinical outcome [5,6] . ANATOMYThe ACL has its origin at the medial area of the lateral femoral condyle and inserts into the center of the eminentia of the tibia plateau next to the anterior horn of the lateral meniscus. The structure of the ACL has been described as two functional bundles: The anteromedial (AM) and the posterolateral (PL) bundle [7] . These two bundles have been associated with different roles in anteroposterior and complex-rotational stabilization of the joint [8][9][10] . The femoral origin was described as oval shaped with a longitudinal diameter of 18 mm and a width of approximately 11 mm [11,12] . ...

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“…1 Among the proposed advantages are low morbidity at the harvest site [2][3][4] ; predictable size and great versatility; and the ability to harvest grafts in different widths, thicknesses, and lengths. 5 The quadriceps tendon graft can be harvested with 6,7 or without a bone block. 8 To completely avoid possible patellar fracture and reduce morbidity at the harvest site, a free bone plug graft is the solution.…”

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Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction

Todor

Caterev

Nistor

et al. 2016

Arthroscopy Techniques

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The most commonly used autografts for anterior cruciate ligament reconstruction are the boneepatellar tendonebone and hamstring tendons. Each has its advantages and limitations. The boneepatellar tendonebone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.T he most commonly used autografts for anterior cruciate ligament (ACL) reconstruction are the boneepatellar tendonebone and hamstring tendons. Recently, there has been an increase in interest in the quadriceps tendon as an autologous graft option for ACL reconstruction. 1 Among the proposed advantages are low morbidity at the harvest site 2-4 ; predictable size and great versatility; and the ability to harvest grafts in different widths, thicknesses, and lengths. 5 The quadriceps tendon graft can be harvested with 6,7 or without a bone block. 8 To completely avoid possible patellar fracture and reduce morbidity at the harvest site, a free bone plug graft is the solution. We present our preferred method of free quadriceps graft harvest for ACL reconstruction and describe how we use a suspensory fixation device for femoral fixation with this type of graft. The harvest method is based on the technique described by Fulkerson and Langeland, 9 but to our knowledge, the cortical button technique has not been described previously. Surgical TechniqueUnder general or spinal anesthesia, the patient is positioned supine on the operating table and the knee flexed to 90 . The skin incision starts from the proximal pole of the patella and extends proximally, in a longitudinal midline fashion, for about 3.5 to 4 cm (Fig 1). After skin and subcutaneous fat incision, the underlying quadriceps tendon is visualized. Medial dissection is

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Minimally Invasive Harvest of a Quadriceps Tendon Graft With or Without a Bone Block

Cited by 69 publications

References 19 publications

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction

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