Primary reconstruction of the anterior cruciate ligament using the central portion of the quadriceps tendon
DOI:
https://doi.org/10.1016/j.rccot.2019.10.004Keywords:
anterior cruciate ligament, quadriceps tendon, central quadriceps tendonAbstract
Background: The use of a free quadriceps tendon graft without the use of a bone plug is not the first choice for primary anterior cruciate ligament reconstruction. A series of patients, with a minimum follow-up of two years, is presented in which the choice of free quadricipital tendon graft without a bone plug will be evaluated as a reliable and safe alternative for primary reconstruction of the anterior cruciate ligament.
Methods: Patients undergoing surgery for a period of 24 months (2013-2015) were included in this study. A follow-up was carried out for a minimum of 2 years. Controls were carried out at 8 and 15 days, when the sutures were removed. The first 2 months were then evaluated every 3 weeks and every 6 weeks for 6 months, and then at 1 year, 18 months, and two years. A record was made of the values obtained by each patient on the Lysholm, Tegner, and IKDC (International Knee Documentation Committee) scales.
Results: The study included 92 patients that met the inclusion criteria. The mean subjective IKDC score at one-year follow-up was 80.44 points, and the mean Tegner activity index reduction was 0.82 index points. The mean Lysholm and Gillquist score was 89 points per year, with good results being obtained in 89.1%.
Discussion: The central quadriceps tendon graft without a bone plug is a technically reproducible procedure with no greater morbidity in the donor site. This has been reflected in the excellent scores on functional scales and in the satisfaction expressed by the patients during two years of follow-up.
Evidence Level: III.
Downloads
References
Blauth BW. 2-strip substitution-plasty of the anterior cruciate ligament with the quadriceps tendón. Unfallheilkunde. 1984;87:45-51.
Kaplan MJ, Howe JG, Fleming B, Johnson RJ, Jarvinen M. Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft Part I. Long-term followup. Am J. Sports Med. 1991;19:447-57. https://doi.org/10.1177/036354659101900505
Kornblatt I, Warren RF, Wickiewicz TL. Long-term followup of anterior cruciate ligament reconstruction using the quadriceps tendon substitution for chronic anterior cruciate ligament insufficiency. Am J Sports Med. 1988;16:444-8. https://doi.org/10.1177/036354658801600503
Staeubli HU. La construcción del hueso del tendón del cuádriceps-patelar para la reconstrucción del LCA. Sports Medicine and Arthroscopy Review. 1997;5:59-67.
Staeubli HU, Bollmann C, Kreutz R, Becker W, Rauschning W. Quantification of intact quadriceps tendon, quadriceps tendon insertion, and suprapatellar fat pad: MR arthrography, anatomy, and cryosections in the sagittal plane. AJR Am J Roentgenol. 1999;173:691-8. https://doi.org/10.2214/ajr.173.3.10470905
Fulkerson JP, Langeland R. An alternative cruciate reconstruction graft: the central quadriceps tendon.Arthroscopy. 1995;11:252-4. https://doi.org/10.1016/0749-8063(95)90078-0
Nagarkatti DG, McKeon BP, Donahue BS, Fulkerson JP. Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation. Am J Sports Med. 2001;29:67-71. https://doi.org/10.1177/03635465010290011601
Geib TM, Shelton WR, Phelps RA, Clark L. Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy. 2009;25:14-408, 10.1016/j.arthro. 06.004 2009. https://doi.org/10.1016/j.arthro.2009.06.004
Shelton WR, Fagan BC. Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg. 2011;19:259-64. https://doi.org/10.5435/00124635-201105000-00003
Fulkerson J, McKeon BP, Donahue BS, et al. El tendón del cuádriceps central como una alternativa versátil para el injerto en la reconstrucción del ligamento cruzado anterior: técnicas y observaciones recientes. Tech Orthop. 1998;13:367-74. https://doi.org/10.1097/00013611-199812000-00006
Fulkerson J. Eltendón libre del cuádriceps central para la reconstrucción del ligamento cruzado anterior. Oper Tech Sports Med. 1999;7:195-200. https://doi.org/10.1016/S1060-1872(99)80026-4
Morgan CD, Leitman EH. tendón del cuádriceps recolección autoinjerto. Surg Tech rodilla. 2005;4:152-7.
Dargel J, Schmidt-Wiethoff R, Schneider T, Brüggemann GP, Koebke J. Biomechanical testing of quadriceps tendon-patellar bone grafts: an alternative graft source for press-fit anterior cruciate ligament reconstruction? Arch Orthop Trauma Surg. 2006;126:265-70. https://doi.org/10.1007/s00402-005-0048-7
Howe JG, Johnson RJ, Kaplan MJ, Fleming B, Jarvinen M. Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part I. Long-term followup. Am J Sports Med. 19: 447-457. https://doi.org/10.1177/036354659101900505
Gorschewsky O1, Klakow A, Pütz 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;15:1284-92. https://doi.org/10.1007/s00167-007-0371-3
Kim DW, Kim JO, You JD, Kim SJ, Kim HK. Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon composite autograft. Arthroscopy. 2001;17:546-50. https://doi.org/10.1053/jars.2001.21834
Kim SJ, Jung KA, Song DH. Arthroscopic double-bundle anterior cruciate ligament reconstruction using autogenous quadriceps tendon. Arthroscopy. 2006;22, 797.e1-5. https://doi.org/10.1016/j.arthro.2005.09.027
Kim SJ, Kumar P, Oh KS. Anterior cruciate ligament reconstruction: autogenous quadriceps tendon-bone compared with bone-patellar tendon-bone grafts at 2-year followup. Arthroscopy. 2009;25:137-44, https://doi.org/10.1016/j.arthro.2008.09.014
Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J. Complications following arthroscopic anterior cruciate ligament reconstruction. A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc. 1999;7:2-8. https://doi.org/10.1007/s001670050112
Adams DJ, Mazzocca AD, Fulkerson JP. Residual strength of the quadriceps versus patellar tendon after harvesting a central free tendon graft. Arthroscopy. 2006;22:76-9. https://doi.org/10.1016/j.arthro.2005.10.015
Almazán Díaz A, Cruz López F, Pérez Jiménez FX, Ibarra Ponce de León JC. Minimally invasive quadriceps tendon harvest. Arthroscopy. 2006;22, 679.e1-3. https://doi.org/10.1016/j.arthro.2005.09.022
Herbort M, Tecklenburg K, Zantop T, Raschke MJ, Hoser C, Schulze M, et al. Single-bundle anterior cruciate ligament reconstruction: a biomechanical cadaveric study of a rectangular quadriceps and bone-patellar tendon-bone graft configuration versus a round hamstring graft. Arthroscopy. 2013;29:1981-90, https://doi.org/10.1016/j.arthro.2013.08.030
Kim SJ, Jo SB, Kim TW, Chang JH, Choi HS, Oh KS. A modified arthroscopic anterior cruciate ligament doublebundle reconstruction technique with autogenous quadriceps tendon graft: remnant-preserving technique. Arch Orthop Trauma Surg. 2009;129:403-7, http://dx.doi.org/10.1007/ s00402-008-0764-x. https://doi.org/10.1007/s00402-008-0764-x
Santori N, Adriani E, Pederzini L. ACL reconstruction using quadriceps tendon. Orthopedics. 2004;27:31-5. https://doi.org/10.3928/0147-7447-20040101-14
Pederzini L, Adriani E, Botticella C, Tosi M. Technical note: double tibial tunnel using quadriceps tendon in anterior cruciate ligament reconstruction. Arthroscopy. 2000;16:E9. https://doi.org/10.1053/jars.2000.7551
Noronha JC. Reconstruction of the anterior cruciate ligament with quadriceps tendon. Arthroscopy. 2002;18:E37. https://doi.org/10.1053/jars.2002.30063
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. https://doi.org/10.2106/JBJS.G.00632
De Angelis JP, Fulkerson J. tendón del cuádriceps, una alternativa fiable para la reconstrucción del ligamento cruzado anterior. Clin Sports Med. 2007;26:587-96.
Joseph M, Fulkerson J, Nissen C, Sheehan TJ. Short-term recovery after anterior cruciate ligament reconstruction: a prospective comparison of three autografts. Orthopedics. 2006;29:243-8, https://doi.org/10.3928/01477447-20060301-14
Fu FH, Bennett CH, Lattermann C, Ma CB. Current trends in anterior cruciate ligament reconstruction Part 1: Biology and biomechanics of reconstruction. Am J Sports Med. 1999;27:821-30. https://doi.org/10.1177/03635465990270062501
Kjaergaard J, Faunø LZ, Faunø P. Sensibility loss after ACL reconstruction with hamstring graft. Int J Sports Med. 2008;29:507-11. https://doi.org/10.1055/s-2008-1038338
Hoeher J, Balke M, Albers M, et al. Ligamento anterior cruzado (ACL) de reconstrucción utilizando un autoinjerto tendón del cuádriceps y pulse-fit fijación tiene resultados equivalentes en comparación con una técnica estándar usando injerto semitendinoso: A matched- prospectivo análisis par después de 1 año. Knee Surg Traumatol Deportes Arthrosc. 2012; 20:147.
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;32:71-5, https://doi.org/10.1016/j.arthro.2015.06.051
Schulz AP, Lange V, Gille J, Voigt C, Fröhlich 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 Nov 19;4:243-9, https://doi.org/10.2147/OAJSM.S49223
Mulford JS, Hutchinson SE, Hang JR. Outcomes for primary anterior cruciate reconstruction with the quadriceps autograft: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2013;21:1882-8, https://doi.org/10.1007/s00167-012-2212-2
Forkel P, Peterse W. Anatomic reconstruction of the anterior cruciate ligament with the autologous quadriceps tendon. Primary and revision surgery. Oper Orthop Traumatol. 2014;26:30-42.
Harris NL, Smith DA, Lamoteaux L, Purnell M, et al. Central quadriceps tendon for anterior cruciate ligament reconstruction, part I: morphometric and biomechanical evaluation. Am J Sports Med. 1997;25:23-8. https://doi.org/10.1177/036354659702500105
Akoto R, Hoeher J. Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft and press-fit fixation using an anteromedial portal technique. BMC Musculoskelet Disord. 2012;13:161, https://doi.org/10.1186/1471-2474-13-161
