ACL Reconstruction Using a Flat Quadriceps Tendon Graft Without Bone Block

2020 ◽  
pp. 81-89
Author(s):  
Christian Fink ◽  
Elisabeth Abermann ◽  
Robert Smigielski ◽  
Rainer Siebold ◽  
Mirco Herbort
Keyword(s):  
Acl Reconstruction ◽  
Quadriceps Tendon ◽  
Tendon Graft ◽  
Bone Block ◽  
Quadriceps Tendon Graft

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

2014 ◽  
Vol 3 (4) ◽  
pp. e509-e513 ◽  
Author(s):  
Christian Fink ◽  
Mirco Herbort ◽  
Elisabeth Abermann ◽  
Christian Hoser
Keyword(s):  
Minimally Invasive ◽  
Quadriceps Tendon ◽  
Tendon Graft ◽  
Bone Block ◽  
Quadriceps Tendon Graft

scholarly journals Continuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All–Soft Tissue Quadriceps Tendon Autografts

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110541
Author(s):  
Christopher M. Gibbs ◽  
Philipp W. Winkler ◽  
Robert T. Tisherman ◽  
Calvin K. Chan ◽  
Theresa A. Diermeier ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Ultimate Load ◽  
Quadriceps Tendon ◽  
Tendon Graft ◽  
Suture Technique ◽  
Suture Fixation ◽  
Full Thickness ◽  
Quadriceps Tendon Graft ◽  
Significant Difference ◽  
Permanent Elongation

Background: Many graft fixation techniques are utilized for full-thickness soft tissue quadriceps tendon autografts during anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the tensile properties of all–soft tissue quadriceps tendon graft fixation using a tied-suture versus continuous-loop tape technique. It was hypothesized that the continuous-loop tape technique would have less cyclic elongation and greater ultimate load to failure and stiffness compared with a commonly used tied-suture technique. Study Design: Controlled laboratory study. Methods: Sixteen fresh-frozen human knee specimens were used to harvest a full-thickness all–soft tissue quadriceps tendon graft; half were secured using a Krackow suture technique with 2 braided sutures, and half were secured using a continuous-loop tape suspensory fixation button with a rip-stop stitch. Cyclic and permanent elongation, toe- and linear-region stiffness, and ultimate load were determined. Statistical analysis was performed at P <.05. Results: The tied-suture fixation group demonstrated significantly higher permanent elongation (11.7 ± 3.6 vs 4.2 ± 1.0 mm, P < .001) and cyclic elongation (5.9 ± 1.3 vs 2.0 ± 0.4 mm, P < .001) compared with the continuous-loop tape fixation group. There was a significantly higher linear-region stiffness with continuous-loop tape fixation compared with tied-suture fixation (98.8 ± 12.7 vs 85.5 ± 7.5 N/mm, P = .022). No significant difference in ultimate load between groups (517.1 ± 149.2 vs 465.6 ± 64.6 N) was found. The mode of failure was tendon pull-through for the continuous-loop tape group and suture breakage in the tied-suture group ( P < .001). Conclusion: Continuous-loop tape fixation is superior to tied-suture fixation in regard to elongation and stiffness for all–soft tissue quadriceps tendon grafts, but there was no significant difference in ultimate load. Clinical Relevance: Continuous-loop tape fixation of all–soft tissue quadriceps tendon grafts for ACLR is a valid technique with superior tensile properties.

scholarly journals Double-Layered Quadriceps Tendon Autografts Provide Lower Failure Rates and Improved Clinical Results Compared With Hamstring Tendon Grafts in Revision ACL Reconstruction

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110469
Author(s):  
Lena Eggeling ◽  
Stefan Breer ◽  
Tobias Claus Drenck ◽  
Karl-Heinz Frosch ◽  
Ralph Akoto
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Failure Rates ◽  
Level Of Evidence ◽  
Quadriceps Tendon Graft ◽  
Patient Reported

Background: We developed a quadriceps-tendon graft technique using a double-layered, partial-thickness, soft tissue quadriceps tendon graft (dlQUAD) for anterior cruciate ligament reconstruction (ACLR). This technique allows simple femoral loop button fixation and a limited harvest depth of the quadriceps tendon. Purpose: To evaluate the outcome of patients undergoing revision ACLR using the dlQUAD technique compared with a hamstring tendon graft (HT). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 114 patients who underwent revision ACLR between 2017 and 2018 were included in this retrospective case series. At a mean follow-up of 26.9 ± 3.7 months (range, 24-36), 89 patients (dlQUAD: n = 43, HT: n = 46) were clinically examined. In addition, patients completed the Lysholm score, Tegner activity scale, subjective International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score, and visual analog scale (VAS) for pain. Postoperative failure of the revision ACLR was defined as a side-to-side difference (SSD) in Rolimeter testing ≥5 mm or a pivot-shift grade of 2 or 3. Results: Nine patients (10.1%) were identified with a failed revision ACLR. There was a significantly lower failure rate with dlQUAD versus the HT group (2.3% vs 17.4%; P = .031). The mean postoperative SSD was significantly less in the dlQUAD group (1.3 ± 1.3 mm [range, 0-5] vs 1.8 ± 2.2 mm [range, 0-9]; P = .043). At the latest follow-up, Tegner and IKDC scores significantly improved in the dlQUAD group compared with the HT group (Tegner: 5.8 ± 1.8 vs 5.6 ± 1.5; P = .043; IKDC: 83.8 ± 12.2 vs 78.6 ± 16.8; P = .037). The pain VAS score was also significantly reduced in the dlQUAD group compared with the HT group (0.9 ± 1.1 vs 1.6 ± 2.0; P = .014). Conclusion: The dlQUAD and HT techniques both demonstrated significant improvement of preoperative knee laxity and satisfactory patient-reported outcome measures after revision ACLR. Compared with the HT grafts, the dlQUAD technique showed lower failure rates and small increases in Tegner and IKDC scores.

Patellar Bone–Tendon–Bone Autografts versus Quadriceps Tendon Allograft with Synthetic Augmentation in a Canine Model

2019 ◽  
Vol 33 (12) ◽  
pp. 1256-1266 ◽  
Author(s):  
Patrick A. Smith ◽  
James P. Stannard ◽  
Chantelle C. Bozynski ◽  
Keiichi Kuroki ◽  
Cristi R. Cook ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Platelet Rich Plasma ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Quadriceps Tendon ◽  
Canine Model ◽  
Tendon Graft ◽  
Donor Site Morbidity ◽  
Tendon Allograft ◽  
Internal Brace

AbstractPatellar bone–tendon–bone (pBTB) autografts are often considered the “gold standard” for complete anterior cruciate ligament (ACL) reconstruction and are also associated with significant complications and early-onset knee osteoarthritis (OA). A novel quadriceps tendon allograft with synthetic augmentation, or “internal brace” (QTIB), has been reported to have potential advantages for ACL reconstruction based on animal model data. In this preclinical canine comparison study, we hypothesized that QTIB allograft compared with pBTB autograft would provide superior durability for knee stability, function, and prevention of OA. Under approval from our Institutional Animal Care and Use Committee, adult purpose-bred research hounds (n = 10) underwent arthroscopic complete transection of the ACL followed by either an arthroscopic-assisted all-inside ACL reconstruction using the QTIB allograft (n = 5) or pBTB autograft (n = 5). Contralateral knees were used as nonoperated controls (n = 10). Radiographic and arthroscopic assessments were performed at 2 and 6 months, respectively, after surgery. Anterior drawer, internal rotation, lameness, kinetics, pain, effusion, and comfortable range of knee motion were measured at 2, 3, and 6 months. Biomechanical and histologic assessments were performed at 6 months. All reconstructed knees were stable and had intact ACL grafts 6 months after surgery. At 6 months, QTIB reconstructed knees had significantly less lameness, lower pain, less effusion, and increased range of motion when compared with BTB knees (p < 0.05). BTB knees had significantly higher radiographic OA scores than QTIB knees at 6 months (p < 0.05). Superior outcomes associated with QTIB allograft may be due to the lack of donor site morbidity, the use of a robust tendon graft, and/or protection of the graft from the synthetic augmentation. Robust tendon grafts combined with a synthetic internal brace and platelet-rich plasma (PRP) may allow for more rapid and robust tendon–bone healing and graft “ligamentization,” which protects the graft from early failure and rapid OA development that can plague commonly-used allografts.

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