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Magnetic resonance imaging of the quadriceps tendon autograft in anterior cruciate ligament reconstruction

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Abstract

Background

Quadriceps tendon (QT) autograft is emerging as a popular technique for primary anterior cruciate ligament (ACL) reconstruction. Studies have shown that it has comparable outcomes to bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts while mitigating post-operative complications associated with these grafts.

Purpose

To provide a literature summary of the important pre- and post-operative magnetic resonance imaging (MRI) findings of the quadriceps tendon and pertinent postoperative complications associated with the QT harvest. Radiologists should be familiar with MR findings after autologous graft harvest of the quadriceps tendon for reconstruction of the ACL.

Level of evidence

Level IV.

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References

  1. van Eck CF, Illingworth KD, Fu FH. Quadriceps tendon: the forgotten graft. Arthroscopy. 2010;26(4):441–2. author reply 442-443.

    Article  Google Scholar 

  2. Middleton KK, Hamilton T, Irrgang JJ, Karlsson J, Harner CD, Fu FH. Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1. Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1467–82.

    Article  CAS  Google Scholar 

  3. Lubowitz JH. Editorial commentary: Quadriceps tendon autograft use for anterior cruciate ligament reconstruction predicted to increase. Arthroscopy. 2016;32(1):76–7.

    Article  Google Scholar 

  4. Adams DJ, Mazzocca AD, Fulkerson JP. Residual strength of the quadriceps versus patellar tendon after harvesting a central free tendon graft. Arthroscopy. 2006;22(1):76–9.

    Article  Google Scholar 

  5. Harris NL, Smith DA, Lamoreaux L, Purnell M. Central quadriceps tendon for anterior cruciate ligament reconstruction. Part I: morphometric and biomechanical evaluation. Am J Sports Med. 1997;25(1):23–8.

    Article  CAS  Google Scholar 

  6. Shani RH, Umpierez E, Nasert M, Hiza EA, Xerogeanes J. Biomechanical comparison of quadriceps and patellar tendon grafts in anterior cruciate ligament reconstruction. Arthroscopy. 2016;32(1):71–5.

    Article  Google Scholar 

  7. Lippe J, Armstrong A, Fulkerson JP. Anatomic guidelines for harvesting a quadriceps free tendon autograft for anterior cruciate ligament reconstruction. Arthroscopy. 2012;28(7):980–4.

    Article  Google Scholar 

  8. Hadjicostas PT, Soucacos PN, Berger I, Koleganova N, Paessler HH. Comparative analysis of the morphologic structure of quadriceps and patellar tendon: a descriptive laboratory study. Arthroscopy. 2007;23(7):744–50.

    Article  Google Scholar 

  9. Gulotta LV, Rodeo SA. Biology of autograft and allograft healing in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26(4):509–24.

    Article  Google Scholar 

  10. Sasaki N, Farraro KF, Kim KE, Woo SL. Biomechanical evaluation of the quadriceps tendon autograft for anterior cruciate ligament reconstruction: a cadaveric study. Am J Sports Med. 2014;42(3):723–30.

    Article  Google Scholar 

  11. Belk JW, Kraeutler MJ, Marshall HA, Goodrich JA, McCarty EC. Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction: a systematic review of comparative studies with minimum 2-year follow-up. Arthroscopy. 2018;34(5):1699–707.

    Article  Google Scholar 

  12. Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E. Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med. 2019;21:363546518825340.

  13. Han HS, Seong SC, Lee S, Lee MC. Anterior cruciate ligament reconstruction: quadriceps versus patellar autograft. Clin Orthop Relat Res. 2008;466(1):198–204.

    Article  Google Scholar 

  14. Kim SJ, Kumar P, Oh KS. Anterior cruciate ligament reconstruction: autogenous quadriceps tendon-bone compared with bone-patellar tendon-bone grafts at 2-year follow-up. Arthroscopy. 2009;25(2):137–44.

    Article  Google Scholar 

  15. Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy. 2001;17(9):971–80.

    Article  CAS  Google Scholar 

  16. Lee S, Seong SC, Jo CH, Han HS, An JH, Lee MC. Anterior cruciate ligament reconstruction with use of autologous quadriceps tendon graft. J Bone Joint Surg Am. 2007;89(Suppl 3):116–26.

    PubMed  Google Scholar 

  17. Geib TM, Shelton WR, Phelps RA, Clark L. Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy. 2009;25(12):1408–14.

    Article  Google Scholar 

  18. Schulz AP, Lange V, Gille J, Voigt C, Frohlich S, Stuhr M, et al. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months. Open Access J Sports Med. 2013;4:243–9.

    Article  Google Scholar 

  19. Hart R, Kucera B, Safi A. Hamstring versus quadriceps tendon graft in double-bundle anterior cruciate ligament reconstruction. Acta Chir Orthop Traumatol Cechoslov. 2010;77(4):296–303.

    CAS  Google Scholar 

  20. Lee JK, Lee S, Lee MC. Outcomes of anatomic anterior cruciate ligament reconstruction: bone-quadriceps tendon graft versus double-bundle hamstring tendon graft. Am J Sports Med. 2016;44(9):2323–9.

    Article  Google Scholar 

  21. Sofu H, Sahin V, Gursu S, Yildirim T, Issin A, Ordueri M. Use of quadriceps tendon versus hamstring tendon autograft for arthroscopic anterior cruciate ligament reconstruction: a comparative analysis of clinical results. Eklem Hastalik Cerrahisi. 2013;24(3):139–43.

    Article  Google Scholar 

  22. Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthroscopy. 2012;28(4):526–31.

    Article  Google Scholar 

  23. Boisvert CB, Aubin ME, DeAngelis N. Relationship between anthropometric measurements and hamstring autograft diameter in anterior cruciate ligament reconstruction. Am J Orthop (Belle Mead NJ). 2011;40(6):293–5.

    Google Scholar 

  24. Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR. Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med. 2013;41(8):1808–12.

    Article  Google Scholar 

  25. Leo BM, Krill M, Barksdale L, Alvarez-Pinzon AM. Failure rate and clinical outcomes of anterior cruciate ligament reconstruction using autograft hamstring versus a hybrid graft. Arthroscopy. 2016;32(11):2357–63.

    Article  Google Scholar 

  26. Alvarez-Pinzon AM, Barksdale L, Krill MK, Leo BM. Hybrid graft anterior cruciate ligament reconstruction: a predictable graft for knee stabilization. Orthopedics. 2015;38(6):e473–6.

    Article  Google Scholar 

  27. Joseph M, Fulkerson J, Nissen C, Sheehan TJ. Short-term recovery after anterior cruciate ligament reconstruction: a prospective comparison of three autografts. Orthopedics. 2006;29(3):243–8.

    Article  Google Scholar 

  28. Andrikoula S, Tokis A, Vasiliadis HS, Georgoulis A. The extensor mechanism of the knee joint: an anatomical study. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):214–20.

    Article  Google Scholar 

  29. Iriuchishima T, Shirakura K, Yorifuji H, Fu FH. Anatomical evaluation of the rectus femoris tendon and its related structures. Arch Orthop Trauma Surg. 2012;132(11):1665–8.

    Article  Google Scholar 

  30. Waligora AC, Johanson NA, Hirsch BE. Clinical anatomy of the quadriceps femoris and extensor apparatus of the knee. Clin Orthop Relat Res. 2009;467(12):3297–306.

    Article  Google Scholar 

  31. Zeiss J, Saddemi SR, Ebraheim NA. MR imaging of the quadriceps tendon: normal layered configuration and its importance in cases of tendon rupture. AJR Am J Roentgenol. 1992;159(5):1031–4.

    Article  CAS  Google Scholar 

  32. Grob K, Ackland T, Kuster MS, Manestar M, Filgueira L. A newly discovered muscle: the tensor of the vastus intermedius. Clin Anat. 2016;29(2):256–63.

    Article  CAS  Google Scholar 

  33. Rajasekaran S, Hall MM. Sonographic appearance of the tensor of the vastus intermedius. PM R. 2016;8(10):1020–3.

    Article  Google Scholar 

  34. Chan KW, Kaplan K, Ong CC, Walsh MG, Schweitzer ME, Sherman OH. Using magnetic resonance imaging to determine preoperative autograft sizes in anterior cruciate ligament reconstruction. Bull NYU Hosp Jt Dis. 2012;70(4):241–5.

    PubMed  Google Scholar 

  35. Todd DC, Ghasem AD, Xerogeanes JW. Height, weight, and age predict quadriceps tendon length and thickness in skeletally immature patients. Am J Sports Med. 2015;43(4):945–52.

    Article  Google Scholar 

  36. Xerogeanes JW, Mitchell PM, Karasev PA, Kolesov IA, Romine SE. Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement. Am J Sports Med. 2013;41(10):2392–9.

    Article  Google Scholar 

  37. Slone HS, Ashford WB, Xerogeanes JW. Minimally invasive quadriceps tendon harvest and graft preparation for all-inside anterior cruciate ligament reconstruction. Arthrosc Tech. 2016;5(5):e1049–56.

    Article  Google Scholar 

  38. Zakko P, van Eck CF, Guenther D, Irrgang JJ, Fu FH. Can we predict the size of frequently used autografts in ACL reconstruction? Knee Surg Sports Traumatol Arthrosc. 2017;25(12):3704–10.

    Article  Google Scholar 

  39. Ashford WB, Kelly TH, Chapin RW, Xerogeanes JW, Slone HS. Predicted quadriceps vs. quadrupled hamstring tendon graft size using 3-dimensional MRI. Knee. 2018;25:1100–6.

    Article  Google Scholar 

  40. Marshall JL, Warren RF, Wickiewicz TL, Reider B. The anterior cruciate ligament: a technique of repair and reconstruction. Clin Orthop Relat Res. 1979;143:97–106.

    Google Scholar 

  41. Blauth W. 2-strip substitution-plasty of the anterior cruciate ligament with the quadriceps tendon. Unfallheilkunde. 1984;87(2):45–51.

    CAS  PubMed  Google Scholar 

  42. Fulkerson JP, Langeland R. An alternative cruciate reconstruction graft: the central quadriceps tendon. Arthroscopy. 1995;11(2):252–4.

    Article  CAS  Google Scholar 

  43. Theut PC, Fulkerson JP, Armour EF, Joseph M. Anterior cruciate ligament reconstruction utilizing central quadriceps free tendon. Orthop Clin N Am. 2003;34(1):31–9.

    Article  Google Scholar 

  44. Fink C, Herbort M, Abermann E, Hoser C. Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthrosc Tech. 2014;3(4):e509–13.

    Article  Google Scholar 

  45. Crall TS, Gilmer BB. Anatomic all-inside anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthrosc Tech. 2015;4(6):e841–5.

    Article  Google Scholar 

  46. Scully WF, Wilson DJ, Arrington ED. “Central” quadriceps tendon harvest with patellar bone plug: surgical technique revisited. Arthrosc Tech. 2013;2(4):e427–32.

    Article  Google Scholar 

  47. Sprowls GR, Robin BN. The quad link technique for an all-soft-tissue quadriceps graft in minimally invasive, all-inside anterior cruciate ligament reconstruction. Arthrosc Tech. 2018;7(8):e845–52.

    Article  Google Scholar 

  48. Kanakamedala AC, de Sa D, Obioha OA, Arakgi ME, Schmidt PB, Lesniak BP, et al. No difference between full thickness and partial thickness quadriceps tendon autografts in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):105–16

    Article  Google Scholar 

  49. Sheean AJ, Musahl V, Slone HS, Xerogeanes JW, Milinkovic D, Fink C, et al. Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often. Br J Sports Med. 2018;52(11):698–701.

    Article  Google Scholar 

  50. Meyers AB, Haims AH, Menn K, Moukaddam H. Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol. 2010;194(2):476–84.

    Article  Google Scholar 

  51. Slone HS, Romine SE, Premkumar A, Xerogeanes JW. Quadriceps tendon autograft for anterior cruciate ligament reconstruction: a comprehensive review of current literature and systematic review of clinical results. Arthroscopy. 2015;31(3):541–54.

    Article  Google Scholar 

  52. Ferrer GA, Miller RM, Murawski CD, Tashman S, Irrgang JJ, Musahl V, et al. Quantitative analysis of the patella following the harvest of a quadriceps tendon autograft with a bone block. Knee Surg Sports Traumatol Arthrosc. 2016;24(9):2899–905.

    Article  Google Scholar 

  53. Fu FH, Rabuck SJ, West RV, Tashman S, Irrgang JJ. Patellar fractures after the harvest of a quadriceps tendon autograft with a bone block: a case series. Orthop J Sports Med. 2019;7(3):2325967119829051.

    Article  Google Scholar 

  54. Palazzolo A, Rosso F, Bonasia DE, Saccia F, Rossi R, Knee Committee S. Uncommon complications after anterior cruciate ligament reconstruction. Joints. 2018;6(3):188–203.

    Article  Google Scholar 

  55. Katz LM, Battaglia TC, Patino P, Reichmann W, Hunter DJ, Richmond JC. A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft. Arthroscopy. 2008;24(12):1330–5.

    Article  Google Scholar 

  56. Schollin-Borg M, Michaelsson K, Rahme H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy. 2003;19(9):941–7.

    Article  Google Scholar 

  57. O’Neill BJ, Molloy AP, McCarthy T. Osteomyelitis of the tibia following anterior cruciate ligament reconstruction. Int J Surg Case Rep. 2013;4(2):143–5.

    Article  Google Scholar 

  58. Frank M, Schmucker U, David S, Matthes G, Ekkernkamp A, Seifert J. Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008;16(1):71–4.

    Article  CAS  Google Scholar 

  59. Bansal A, Lamplot JD, VandenBerg J, Brophy RH. Meta-analysis of the risk of infections after anterior cruciate ligament reconstruction by graft type. Am J Sports Med. 2018;46(6):1500–8.

    Article  Google Scholar 

  60. Benner RW, Shelbourne KD, Urch SE, Lazarus D. Tear patterns, surgical repair, and clinical outcomes of patellar tendon ruptures after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. Am J Sports Med. 2012;40(8):1834–41.

    Article  Google Scholar 

  61. Lee GH, McCulloch P, Cole BJ, Bush-Joseph CA, Bach BR Jr. The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction. Arthroscopy. 2008;24(2):162–6.

    Article  Google Scholar 

  62. Milankov Ziva M, Semnic R, Miljkovic N, Harhaji V. Reconstruction of patellar tendon rupture after anterior cruciate ligament reconstruction: a case report. Knee. 2008;15(5):419–22.

    Article  Google Scholar 

  63. Pandey V, Madi S, Joseph A, Acharya K. Late quadriceps tendon rupture at the donor site following cruciate ligament reconstruction using central quadriceps tendon graft. BMJ Case Rep. 2015;2015:bcr2015212621.

    Article  Google Scholar 

  64. Gorschewsky O, Klakow A, Putz A, Mahn H, Neumann W. Clinical comparison of the autologous quadriceps tendon (BQT) and the autologous patella tendon (BPTB) for the reconstruction of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2007;15(11):1284–92.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. The University of Miami Sports Medicine Institute, Department of Orthopaedic Surgery, The University of Miami Miller School of Medicine, Coral Gables, FL, USA

    Christopher P. Emerson, Jessica M. Bernstein, Spencer Barnhill & Michael G. Baraga

  2. Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

    Fong Nham

  3. Department of Radiology, Hospital for Special Surgery, New York, NY, USA

    Eric Bogner

  4. Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA

    Jean Jose

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  1. Christopher P. Emerson
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  2. Jessica M. Bernstein
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  3. Fong Nham
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Correspondence to Christopher P. Emerson.

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Emerson, C.P., Bernstein, J.M., Nham, F. et al. Magnetic resonance imaging of the quadriceps tendon autograft in anterior cruciate ligament reconstruction. Skeletal Radiol 48, 1685–1696 (2019). https://doi.org/10.1007/s00256-019-03235-8

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  • DOI: https://doi.org/10.1007/s00256-019-03235-8

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