Advance with MUSC Health

Q&A: Orthopaedic Surgeon on the Advantages of Quad Tendon Autograft in ACL Reconstruction

Advance With MUSC Health
September 19, 2023
Person in athletic wear on a beach massaging their right quadracep.

Quad tendon autograft, a cutting-edge technique in ACL reconstruction, is gaining recognition for its advantages in restoring knee function. Surgeons like Dr. Emanuel Rivera-Rosado at MUSC Health Florence Medical Center are harnessing the power of the quadriceps tendon to provide patients with improved outcomes in ACL repair.

For years, surgeons used the bone-patellar tendon-bone (BPTB), considered the gold standard, or the hamstring tendon (HT) autografts. With a growing number of surgeons choosing to use the quadriceps tendon autograft instead, Dr. Rivera-Rosado is here to discuss its distinct advantages for the patient and the surgeon.

What is quad tendon autograft?

When the anterior cruciate ligament (ACL) is torn, usually through sports injuries, accidents or twisting injuries, reconstructive surgery may be necessary to restore function, mobility, strength, and stability in the knee.

What are the symptoms of a torn ACL?

Athletes, particularly football, basketball and soccer players, are most at risk for ACL injuries. A torn ACL can lead to cartilage and meniscal damage inside the knee. Symptoms include:

  • Swelling
  • Pain
  • Diminished range of motion
  • Inability to walk or put weight on the leg.
  • Instability

What is the importance of the quadriceps tendon? What does it do?

The quadriceps tendon is located on the front of the thigh above the knee and connects muscles to the patellar bone, or knee cap. Its main function is to extend and stabilize the knee.

What is quadriceps autograft ACL reconstruction?

An autograft is the patient’s own tissue. In quadriceps tendon autograft, surgeons use the patient’s own quadriceps tendon to reconstruct the ACL instead of using tissue from a donor, a technique known as an allograft.

What are the advantages of autograft ACL reconstruction?

The quad tendon is thick, strong tissue. We can get the exact size and thickness that we plan to use. need, which is very important. The chances of autograft infection are lower, and patients have less pain in the front of the knee than with the patellar tendon autograft. After full recovery, people feel little to no pain when kneeling. We take about 25 to 30 percent of a patient’s quad tendon so the patient’s remaining quad tendon remains strong.

How will I know if I need ACL reconstructive surgery?

A doctor will perform simple physical tests:

  • Pull the lower part of your leg from your thigh to test for stability.
  • Rotate the leg to test for range of motion.
  • If the bones are loose and they shift, surgery may be recommended.

Am I a suitable candidate for ACL reconstruction?

Many of my patients are athletes. The best candidates are younger, active patients in their 20s to 40s. ACL reconstruction provides better stability to the knee.

Because many older people have arthritis, we typically don’t perform this surgery on patients over 50 unless they’re very active. We do not recommend this surgery for sedentary patients and will use other treatments to ease pain and restore function.

What do you tell your patients about the surgery?

I want my patients to be fully informed of their options, so I discuss in detail the procedures available to them. Quadriceps tendon grafts have been the subject of many studies and articles in recent years. Most will choose the autograft.

I have been performing quad autograft surgery for four years and am very comfortable using it. My patients who have had this surgery are also pleased with the outcome.

What happens during surgery?

Surgery is an outpatient procedure and takes from one hour to 90 minutes. A nerve block is used for pain. Three small incisions are made.

A small incision, about three to four centimeters, is made just above the knee to remove the portion of the tendon used for reconstruction. I make a second, smaller incision in the tibia for fixation of the tendon graft. I also use standard arthroscopic portals for visualization.

What can I expect during recovery?

Patients can walk afterward and must wear a knee brace for protection and stabilization for four weeks. The brace allows patients to regain their strength and motion without causing stress to the knee.

The quad tendon reconstruction, which is soft tissue to bone, takes 12 weeks to heal, compared with the BPTB graft option, which takes eight weeks. The physical therapy regimen, however, is the same.

When do patients begin physical therapy?

Patients begin home exercises one week after surgery. Outpatient therapy, which is progressive and emphasizes motion, strength and movement to protect the graft, can take at least 12 weeks and sometimes longer for athletes.

Patients usually go two to three times a week. We always recommend doing a home exercise program during and after therapy is completed.

When can I resume sports activities?

We tell our patients to expect a year before they can return to play. The earliest is at least six months, depending on the activity.

What about long-term outcomes?

Long-term outcomes are very favorable. Patients regain their full mobility and range of motion, stability and strength, and cosmetic outcomes are also good. The longevity of the quad tendon is the same as other reconstruction methods, and the patient’s remaining portion of the quad tendon is strong.

Quad tendon autografts stand as a promising option in the field of ACL reconstruction, offering patients enhanced stability, reduced pain and a faster return to an active lifestyle. Dr. Emanuel Rivera-Rosado's expertise in this innovative technique highlights its potential to transform the landscape of knee surgery and provide lasting benefits to those in need.