Quad tendon autografts for ACL reconstruction
This year has been a year of orthopedic firsts in my 21-year career. I have already written forum posts on orthobiologics and robotic assisted total knee arthroplasty. Last week I assisted in my first quadricep tendon ACL reconstruction.
ACL graft choice has been a topic of debate for as long as I have been in orthopedics. Hamstring vs. Patellar tendon, and autograft vs. allograft likely being the most debated. Within my practice, we typically use Patellar tendon autografts in patients under the age of 30 and tibialis anterior allograft in patients over 30. There are always outliers – patient graft choice, previous surgery, to name a couple.
We have just hired a new sports orthopedist. His preference is quad tendon autograft in the younger patient. In researching this option – I found that there is debate as to whether just tendon should be used or tendon with patellar bone plug. I found graft preparation to be very similar to Achilles tendon allograft preparation (although not having to prep as large a bone graft). The bone plug is prepped to a size 9 or 10 with one fiber wire passing stitch. The tendon end is then whipped stitched approximately 15 mm. The rest of the case goes similar to other ACL surgeries.
When talking with the surgeon who performed the surgery, I found his reasons for performing Quad tendon reconstructions were three fold. The use of quad tendon autograft supposedly decreases kneeling pain, graft site pain, and sensitivity loss when compared to Patellar tendon autograft.
With three new techniques and surgeries I have learned in my 21st year, I am looking forward to what lies ahead to learn in my 22 year. Happy Holidays to all of the PAOS.