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Skeletal Radiology
Published in: Skeletal Radiology 11/2019

01-11-2019 | Magnetic Resonance Imaging | Review Article

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

Authors: Christopher P. Emerson, Jessica M. Bernstein, Fong Nham, Spencer Barnhill, Michael G. Baraga, Eric Bogner, Jean Jose

Published in: Skeletal Radiology | Issue 11/2019

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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.
Literature
1.
van Eck CF, Illingworth KD, Fu FH. Quadriceps tendon: the forgotten graft. Arthroscopy. 2010;26(4):441–2. author reply 442-443.CrossRef
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.CrossRef
3.
Lubowitz JH. Editorial commentary: Quadriceps tendon autograft use for anterior cruciate ligament reconstruction predicted to increase. Arthroscopy. 2016;32(1):76–7.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
9.
Gulotta LV, Rodeo SA. Biology of autograft and allograft healing in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26(4):509–24.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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
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.CrossRef
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.CrossRef
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.
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.CrossRef
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.CrossRef
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.CrossRef
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.
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
33.
Rajasekaran S, Hall MM. Sonographic appearance of the tensor of the vastus intermedius. PM R. 2016;8(10):1020–3.CrossRef
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
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.
41.
Blauth W. 2-strip substitution-plasty of the anterior cruciate ligament with the quadriceps tendon. Unfallheilkunde. 1984;87(2):45–51.PubMed
42.
Fulkerson JP, Langeland R. An alternative cruciate reconstruction graft: the central quadriceps tendon. Arthroscopy. 1995;11(2):252–4.CrossRef
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.CrossRef
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.CrossRef
45.
Crall TS, Gilmer BB. Anatomic all-inside anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthrosc Tech. 2015;4(6):e841–5.CrossRef
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.CrossRef
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.CrossRef
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):105–16CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
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.CrossRef
Metadata
Title
Magnetic resonance imaging of the quadriceps tendon autograft in anterior cruciate ligament reconstruction
Authors
Christopher P. Emerson
Jessica M. Bernstein
Fong Nham
Spencer Barnhill
Michael G. Baraga
Eric Bogner
Jean Jose
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 11/2019
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-019-03235-8

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