Abstract
PurposeThe quadriceps tendon (QT) is an autograft option for primary and revision anterior cruciate ligament (ACL) reconstruction. Techniques for predicting the appropriate graft size are limited. The purpose of this study was to evaluate the morphologic features of the QT in cadaveric specimens and compare the findings to recent MRI studies.Materials and MethodsMacroscopic dissections were performed on 10 cadaveric knees. Using the distal myotendinous junction of the rectus femoris and superior pole of the patella as anatomic landmarks, the QT was isolated. Tendon length, width, and thickness were recorded at 10 millimeter (mm) increments. A central 80 mm x 10 mm graft was harvested, after which the graft was measured in an identical fashion. Specimen anthropometric data was collected. Subgroup analysis and linear regression were then performed using Microsoft Excel 2011 Office Analysis ToolPak.ResultsThe mean QT length was 83.3 +/- 14.4 mm, ranging from 63 to 108 mm. The mean percentage of remaining QT volume following graft harvesting was 63.3%. QT length showed significant correlation with patient height (correlation coefficient: 0.719, p = 0.027). QT thickness remained relatively constant, while the width is greatest at its patellar insertion and gradually decreases proximally towards the myotendinous junction.ConclusionThe QT has the anatomical features to produce a robust autograft for ACL reconstruction. During preoperative evaluation of graft size and quality, patient height should be considered as it is strongly correlated with the length of the potential graft. Our findings support the use of MRI as a way to preoperatively assess the QT as an autograft when performing an ACL reconstruction.
Highlights
There has been a recent resurgence of interest in the use of the quadriceps tendon (QT) as a potential graft choice in primary anterior cruciate ligament (ACL) reconstructions.[1,2,3]
bone-patella tendon-bone (BPTB) and hamstrings autografts have historically served as the primary graft options for ACL reconstructions, the favorable clinical outcomes observed with the use of QT autograft have recently received considerable attention.[8,9,10,11,12]
We found that the volume of the QT graft and the percentage of the remaining tendon are greater than what has been previously reported of the bonepatella tendon-bone graft in similar anatomic studies using 3D magnetic resonance imaging (MRI) techniques.[23]
Summary
There has been a recent resurgence of interest in the use of the quadriceps tendon (QT) as a potential graft choice in primary anterior cruciate ligament (ACL) reconstructions.[1,2,3] The most utilized autograft choices have historically been bone-patella tendon-bone (BPTB) and the hamstrings, which have both proven to be reliable in terms of graft quality and clinical outcomes.[4] the QT has provided a favorable graft option in certain settings,[5] the indications for its use may begin to expand.[6] the magnetic resonance imaging (MRI) assessment of QT characteristics has recently been shown to correlate with intraoperative autograft findings,[7] there is still limited data on the gross anatomic features of the tendon. The purpose of our study was to analyze the morphology of the QT and correlate the measurements to comparable studies done using MRI. Our hypothesis was that the morphological features of the QT in cadaveric specimens would be concordant with data produced from QT assessment done by MRI studies
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