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Minimally Invasive Anterior Cruciate Ligament (ACL) Reconstruction Using Quadriceps Tendon

By: S. Evan Carstensen, MD

The ACL provides anterior and rotational stability to the knee.  However, more than 100,000 ACL tears occur every year in the United States leading to instability and possibly earlier degeneration of the cartilage in the knee. Patients often tear their ACL and feel as though they cannot “trust” their knee.  The ligament tear is diagnosed on physical exam and often confirmed by magnetic resonance imaging (MRI).

ACL reconstruction is completed arthroscopically using small incisions around the knee allowing a camera to view the inside of the joint.  In younger patients, the ACL is typically reconstructed using a patient’s own tissue (autograft) while alternative options include graft taken from a cadaver (allograft), though these rupture at a significantly higher rate.

Various techniques exist to harvest a patient’s hamstring tendons, patellar tendon, or quadriceps tendon for use as a replacement for the ACL.  Historically, the patellar tendon or hamstrings have been used as the graft for reconstructing the ACL.  Patellar tendon requires a long vertical incision on the front of the knee which may lead to anterior knee pain.  Alternatively, hamstring tendons may yield a graft that is too small and at higher risk of rerupture. Newer techniques include use of an all soft tissue quadriceps tendon graft which is harvested through a small (1-1.5cm) horizontal incision above the kneecap. This incision not only heals better cosmetically, but also yields a more consistent graft size that can be specially tailored to the needs of the patient with less graft site pain. 

The quadriceps tendon autograft has been used in a wide array of patients from recreational to professional athletes with excellent outcomes.  Additionally, it can also be used in revision ACL reconstructions where a patient has previously had their ACL surgically reconstructed.  Given the excellent outcomes, less graft harvest pain, better cosmesis, and graft consistency, quadriceps tendon autograft should be considered for your ACL reconstruction.

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