Quadriceps tendon autograft is an effective alternative graft for posterior cruciate ligament reconstruction in isolated or multiligament injuries: a systematic review

McCadden, Austin; Akelman, Matthew R.; Traven, Sophia A.; Woolf, Shane K.; Xerogeanes, John W.; Slone, Harris S.

doi:10.1136/jisakos-2020-000487

Cited by 4 publications

(5 citation statements)

References 50 publications

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“…18 In addition, the QT bone block autograft is considered a valuable graft option for posterior cruciate ligament (PCL) reconstruction. 16,40,48 In contrast, using QT grafts without a bone block for ACL reconstruction is suitable in cases of open physes and avoids the fracture risk, but slower graft-to-tunnel healing has to be accepted. 13 Although a patellar fracture is a known morbidity after QT harvesting with a bone block, there is a lack of literature on this subject.…”

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confidence: 99%

Patellar Size Variation at the Quadriceps Tendon–Bone Block Harvest Site: A Magnetic Resonance Imaging Study to Evaluate the Safe Zone for Harvesting a Sufficient Bone Block

2021

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Background: Quadriceps tendon (QT) autografts with and without a bone block are the least studied and least used options for anterior cruciate ligament reconstruction surgery. In particular, there is a lack of literature describing patellar anatomy. Until now, guidelines for patellar bone block harvesting have been based solely on personal experience. In this study, we intended to derive recommendations from physical regularities and objective criteria. Purpose: To determine the maximal, individual-related length and depth of the bone block that can be safely harvested and to provide guidelines to help surgeons make decisions on graft choice. Study Design: Descriptive laboratory study. Methods: The study group consisted of 50 male participants and 50 female participants (mean age, 29.4 ± 7.9 years) who underwent 3.0-T magnetic resonance imaging of their knee. Patellar height was determined at the center of the middle third of the QT insertion on the patella and the medial and lateral endpoints; the depth was measured at the midpoints of the respective heights. Results: The mean width of the QT and the mean thickness were 49.0 ± 7.6 and 7.3 ± 1.0 mm, respectively. The mean patellar thickness in reference to the medial endpoint, the center, and the lateral endpoint was 18.3 ± 2.4, 17.9 ± 2.3, and 15.1 ± 2.3 mm, respectively, whereas the mean patellar height was 35.1 ± 4.1, 36.7 ± 4.2, and 35.1 ± 3.9 mm. In general, the tendon and patellar dimensions were significantly larger in male participants than in female participants ( P = .016). Conclusion: Bone block harvesting, with its depth not exceeding 50% of the patellar thickness and its length accounting for <50% of the patellar height, poses the least risk for a patellar fracture when located medial to midline. If the bone block is excised from the medial half of the central area (the latter is defined by the middle third of the QT insertion), with the outer edge of the saw positioned at the medial border of the central area, a graft of 15 mm length, 10 mm width, and 8 mm depth can be safely harvested in all White male participants and almost all female participants taller than 165 cm, according to our findings. Clinical Relevance: This is the first study presenting recommendations for patellar bone block harvesting at the quadriceps tendon insertionbased on physical regularities and objective criteria and not on personal experience.

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confidence: 99%

Patellar Size Variation at the Quadriceps Tendon–Bone Block Harvest Site: A Magnetic Resonance Imaging Study to Evaluate the Safe Zone for Harvesting a Sufficient Bone Block

2021

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“…However, the technique we described is not without limitations: compared with allograft, a proper graft diameter and length may be difficult to obtain with autogenous grafts ( Table 3 ). 2 Also, harvesting the QT-B could cause donor-site morbidity, risk of patellar fractures, and increased operative time ( Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…Some evidence suggests that the use of autograft may reduce posterior laxity compared with allograft tendon; however, one of the main concerns is to obtain a thickness good enough to replace the native PCL. 1 , 2 …”

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confidence: 99%

All-Inside Posterior Cruciate Ligament Reconstruction Using Autologous Quadriceps Tendon–Bone Block

Pettinari,

Franco,

Conoscenti

et al. 2023

Arthroscopy Techniques

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“…They are not as commonly associated with PCL tears and there is limited literature looking at the 2 injuries in combination. 1,2,4,6 Diagnosis of a PCL tear is made with physical examination maneuvers, stress radiographs, and MRIs. 3,8,11 On physical examination, the posterior drawer sign is the most accurate, but a posterior sag sign and a dial test can be done.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…They are not as commonly associated with PCL tears and there is limited literature looking at the 2 injuries in combination. 1,2,4,6…”

Section: Video Transcriptmentioning

confidence: 99%

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

Glover,

Mason,

Albertson

et al. 2024

Video Journal of Sports Medicine

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Background: Quadriceps autograft, though well established for anterior cruciate ligament reconstruction, is underutilized in posterior cruciate ligament (PCL) reconstruction largely due to slow adoption. All-inside meniscal ramp repair and quadriceps tendon autograft PCL reconstruction have been described in isolation, but not concomitantly in a video journal. Indications: PCL reconstruction is indicated in grade 3 isolated tears with instability that have not improved with nonoperative management and in instances with associated injuries such as meniscal ramp tears, as observed in this 18-year-old division I football player. Graft selection is dependent upon surgeon and patient preference, with quadriceps autograft delivering a viable option with desirable long-term outcomes. Technique Description: A partial-thickness quadriceps tendon autograft was harvested, the remnant PCL stump was debrided, and a reamer was used to drill the all-inside tibial tunnel for traction suture passage. An accessory low anterolateral portal was utilized to drill the femoral tunnel for passage of the femoral traction stitch. Traction sutures were withdrawn, and the graft was passed into the tibia, docked into the femur, fixated with an interference screw, and tensioned over the tibial button. A medial meniscal ramp tear was also identified and repaired in all-inside fashion with a 90° SutureLasso, polydioxanone suture (PDS), and suturetape via standard arthroscopic knot tying. Following the procedure, the patient began a PCL reconstruction rehabilitation protocol with a PCL rebound brace. Due to the meniscal ramp repair, toe touch weightbearing with the knee in extension during ambulation was completed for 6 weeks. Physical therapy (PT) focused on early quadriceps and patellar mobilization as well as active-assisted range of motion exercises. Results: At 6 months postoperation, the patient continued to progress in PT without major concerns. A full recovery and return to sport are expected approximately 9 to 12 months after surgery, as is consistent with the standard protocol. Discussion/Conclusion: This study describes the treatment of chronic PCL with concomitant meniscal ramp tear in a division I athlete. Further adoption of PCL reconstruction utilizing quadriceps autograft, even in the context of concomitant ligamentous or meniscal reconstruction, such as medial meniscal ramp repair, will aid in the widespread treatment of PCL injuries. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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Quadriceps tendon autograft is an effective alternative graft for posterior cruciate ligament reconstruction in isolated or multiligament injuries: a systematic review

Cited by 4 publications

References 50 publications

Patellar Size Variation at the Quadriceps Tendon–Bone Block Harvest Site: A Magnetic Resonance Imaging Study to Evaluate the Safe Zone for Harvesting a Sufficient Bone Block

Patellar Size Variation at the Quadriceps Tendon–Bone Block Harvest Site: A Magnetic Resonance Imaging Study to Evaluate the Safe Zone for Harvesting a Sufficient Bone Block

All-Inside Posterior Cruciate Ligament Reconstruction Using Autologous Quadriceps Tendon–Bone Block

Posterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft and Concomitant Meniscal Ramp Repair

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