Quadriceps Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies With Minimum 2-Year Follow-Up

Belk, John W.; Kraeutler, Matthew J.; Marshall, Hayden; Goodrich, Jesse A.; McCarty, Eric C.

doi:10.1016/j.arthro.2018.01.047

Cited by 66 publications

(73 citation statements)

References 28 publications

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“…Another potential risk with MQTFL reconstruction is violation of the suprapatellar joint capsule during development of the intratendinous plane in the medial QT. This is a similar risk with QT harvest for anterior cruciate ligament reconstruction; violation of the suprapatellar capsule has not been described as detrimental to patient outcomes in these cases 21, 22, 23. The authors have never found this to be a problem.…”

Section: Discussionmentioning

confidence: 98%

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Medial Quadriceps Tendon Femoral Ligament Reconstruction Technique and Surgical Anatomy

Joseph

Fulkerson

2019

Arthroscopy Techniques

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Medial patellofemoral ligament reconstruction risks patellar fracture with the osseous violation necessary for patellar attachment. Anatomic studies identify an entire medial patellofemoral complex of structures responsible for medial restraint to patellar lateral instability. One specific component of this complex is the medial quadriceps tendon femoral ligament (MQTFL). This note presents the technique, pearls and pitfalls, and critical surgical anatomy necessary for successful MQTFL reconstruction—a treatment strategy for patellar instability with no increased risk for patellar fracture. An autograft hamstring tendon or allograft tendon is fixed to the anatomically identified femoral origin and passed deep to the vastus medialis obliquus to then weave around the distal medial quadriceps tendon. This simulates the native anatomic interdigitation of the MQTFL with the quadriceps tendon and provides a stable restraint to prevent lateral patellar subluxation or dislocation.

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Section: Discussionmentioning

confidence: 98%

“…This is a similar risk with QT harvest for anterior cruciate ligament reconstruction; violation of the suprapatellar capsule has not been described as detrimental to patient outcomes in these cases. 21 , 22 , 23 The authors have never found this to be a problem.…”

Section: Discussionmentioning

confidence: 99%

Medial Quadriceps Tendon Femoral Ligament Reconstruction Technique and Surgical Anatomy

Joseph

Fulkerson

2019

Arthroscopy Techniques

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“…ACL reconstruction is a common procedure that yields good functional outcomes regardless of the technique or graft used. 4,13,25,54 However, risk factors such as ethnicity, history of bleeding disorders, or use of epidural anesthesia have been associated with an increased risk of hospital readmissions in the short-term postoperative period. 10 A longer operative time has been previously recognized as a risk factor for short-term complications after various orthopaedic procedures 8,9 ; however, it has yet to be investigated as an independent risk factor for postoperative complications after ACL reconstruction.…”

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confidence: 99%

Effect of Operative Time on Short-Term Adverse Events After Isolated Anterior Cruciate Ligament Reconstruction

Agarwalla

Gowd

Liu

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: A longer operative time has been previously recognized as a risk factor for short-term complications after various orthopaedic procedures; however, it has yet to be investigated as an independent risk factor for postoperative complications after anterior cruciate ligament (ACL) reconstruction. Purpose: To identify whether a longer operative time in ACL reconstruction is an independent risk factor for the development of postoperative complications, hospital readmissions, or an extended length of stay within 30 days of the index procedure. Study Design: Descriptive epidemiology study. Methods: Patients undergoing ACL reconstruction between 2005 and 2016 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Cases with concomitant procedures were excluded from the analysis. We evaluated the association between operative time and preoperative variables such as patient age, sex, body mass index, comorbidities, and procedure. Correlations between adverse events and operative time, while controlling for the above preoperative variables, were calculated using multivariate Poisson regression with robust error variance. Results: A total of 14,159 procedures were included in this investigation. The mean patient age was 32.6 ± 10.8 years, the mean body mass index was 27.7 ± 6.5 kg/m 2 , and the mean operative time was 89.7 ± 28.6 minutes. Patients who were between the ages of 18 and 30 years (mean operative time, 95.1 ± 27.8 minutes; relative risk [RR], 17.7; P < .001), male (mean operative time, 91.9 ± 28.3 minutes; RR, 4.7; P < .001), and nondiabetic (mean operative time, 89.8 ± 28.6 minutes; RR, 7.1; P = .011) were associated with a longer operative duration. The overall complication rate was 1.1%. After adjusting for demographic characteristics and procedures, 15-minute incremental increases in operative duration were associated with an increased risk of deep vein thrombosis (RR, 1.12; P = .042), surgical site infections (RR, 1.21; P = .001), and sepsis (RR, 1.66; P < .001) as well as increased readmission rates (RR, 1.23; P = .001) and an extended length of stay (RR, 1.18; P = .008). Conclusion: While the overall adverse risk rate after ACL reconstruction remains low, marginal increases in operative time are associated with an increased risk of adverse events such as deep vein thrombosis, surgical site infections, sepsis, an extended length of stay, and readmissions. Thus, the operating physician and surgical staff should make all efforts to coordinate and prepare for each case to maximize surgical efficiency.

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“…Belk et al. 27 reported that patients undergoing primary ACLR with either a quadriceps tendon, bone–patellar tendon–bone, or hamstring autograft experience improvement in clinical outcomes. QT patients experienced less knee laxity postoperatively compared with HT patients, although no significant differences were found in graft failure rate between groups.…”

Section: Discussionmentioning

confidence: 99%

Biologically Augmented Quadriceps Tendon Autograft With Platelet-Rich Plasma for Anterior Cruciate Ligament Reconstruction

Chahla

Cinque

Mandelbaum

2018

Arthroscopy Techniques

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Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures studied in the orthopaedic literature. In this regard, graft preparation is a key factor for successful outcomes. Although current methods to reconstruct the ACL are generally perceived to be successful, recent studies indicate that normal structure and function of the knee are fully restored in less than half of the patients. Therefore, biologically augmenting these scaffolds could provide a potential solution for improving healing times and biomechanical properties of the graft. The purpose of this Technical Note is to describe our preferred technique for an ACL graft preparation (quadriceps tendon) augmented with platelet-rich plasma.

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Quadriceps Tendon Autograft for Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review of Comparative Studies With Minimum 2-Year Follow-Up

Cited by 66 publications

References 28 publications

Medial Quadriceps Tendon Femoral Ligament Reconstruction Technique and Surgical Anatomy

Medial Quadriceps Tendon Femoral Ligament Reconstruction Technique and Surgical Anatomy

Effect of Operative Time on Short-Term Adverse Events After Isolated Anterior Cruciate Ligament Reconstruction

Biologically Augmented Quadriceps Tendon Autograft With Platelet-Rich Plasma for Anterior Cruciate Ligament Reconstruction

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