Minimally Invasive Quadriceps Tendon Anterior Cruciate Ligament Reconstruction Using the Quadriceps Tendon Harvest Guide System
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PROVIDER: S-EPMC10995694 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Quadriceps tendon autografts are an increasingly popular choice for anterior cruciate ligament (ACL) reconstruction, with decreased donor-site morbidity alongside good patient outcomes. Although harvesting of the tendon can be done in a minimally invasive fashion, this introduces some difficulty with visualization and consistency of graft sizing. The purpose of this Technical Note and video is to provide a method of quadriceps tendon autograft harvesting using the Quadriceps Tendon Harvest Guide System (QUADTRAC) in a single-bundle ACL reconstruction.
| S-EPMC10837787 | biostudies-literature
Project description:The quadriceps tendon is an infrequently used graft option for anterior cruciate ligament reconstruction despite favorable clinical results in the literature with low donor site morbidity. It is a versatile graft that can be harvested with bone or as a soft tissue graft alone. In addition, it can be used for anatomic, double-bundle, transtibial, and all-inside reconstructions. The unique characteristics of the quadriceps tendon allow for the ability to harvest a single-bundle large-diameter graft and minimize disruption of normal anatomy, which makes the quadriceps tendon an excellent choice for all-inside techniques. Recently developed minimally invasive harvest techniques described in this note allow for a reproducible predictable and efficient harvest through a small incision.
| S-EPMC5124375 | biostudies-literature
Project description:Recent systematic reviews have shown anterior cruciate ligament reconstruction using quadriceps tendon (QT) grafts to have superior clinical outcomes compared with traditional bone–patella tendon–bone and hamstring tendons grafts. Using minimally invasive techniques to harvest the QT graft can reduce postoperative pain and intraoperative surgical time. This technique is usually performed with a distal-to-proximal approach but often has issues of inadvertently harvesting a graft short of the desired length or causing a hematoma. As an alternative, we introduce a minimally invasive approach with a proximal-to-distal harvest technique that results in better visualization of tissue planes, more consistent graft sizes, lower risk of inadvertent arthrotomy, and reduced risk of hematoma. The minimally invasive QT graft harvest with a proximal-to-distal approach can offer unique advantages over the current standard distal-to-proximal approach. Technique Video Video 1 In this video, we demonstrate a novel technique for harvesting the quadriceps tendon (QT) for anterior cruciate ligament reconstruction. The patient is supine on the operating table with the leg flexed over the side of the bed for dissection and harvest. The harvest can be adequately done with a 2-cm horizontal incision approximately 8 to 9 cm proximal to the patella. Before the incision the vastus medialis obliquus, rectus femoris (RF), and patella are outlined. The Arthrex QuadPro can be used as a ruler as seen here. Through a 2-cm horizontal incision, subcutaneous fat is dissected to reveal the facial envelope of the RF and QT. A split is made in the fascia, which usually reveals a small amount of fat overlying the tendon. Pretendinous fat and adhesions are removed to expose the RF tendon. The next step is to feather off the musculotendinous junction. At this proximal level, the muscle of the quadriceps begins to envelope the tendon making the tendon width appear smaller than it actually is. This can be done with a scalpel, key elevator, knife, Cobb, or any other sharp instrument. Adequate feathering of the muscle bellies will show a wide tendon adequate for harvest. A rectangular-shaped tenotomy consistent with the harvester diameter or slightly larger is performed in the RF tendon. Below, the VI will come into view. This is a proximal to distal view of the plane between the RF and VI. The RF is then quickly whip stitched. Blunt dissection is performed above and below the RF tendon to allow easier passage of the harvester. The graft is loaded into the harvester. We know from anatomical studies that the tendon 2-cm distal to our tenotomy should begin to splay out and widen. Furthermore, the central aspect of the RF tendon is not in the center of the patella but about 10% lateral due to the Q angle of the tendon. Therefore, direct visualization of the harvest path 2-cm distal and aiming at the proximal pole of the patella just off center laterally should minimize the risk of poor trajectory leading to short graft harvest. The desired length is seen on the harvester and the graft is amputated. A 9-mm harvester was used in this example, which yields a graft that will easily pass through the corresponding tunnel or will be a snug fit slightly smaller as seen. There are various graft fixation methods. A reliable and reproducible fixation method is the Arthrex FiberTag.
| S-EPMC9705914 | biostudies-literature
Project description:Many surgeons use quadriceps tendon (QT) graft for anterior cruciate ligament (ACL) revision surgery; however, despite excellent clinical results, the QT has not achieved universal acceptance for primary ACL reconstruction. One of the reasons for this may be that the QT is technically demanding to harvest and the scar from open harvesting techniques is less cosmetically favorable than that from hamstring tendon techniques. Recent evidence has suggested that broad flat QT grafts may more closely mimic native ACL "ribbon-like" morphology than hamstring tendon grafts. Furthermore, rectangular bone tunnels may more accurately re-create native ACL attachments, allowing grafts to simulate native ACL rotation during knee flexion and potentially improving biomechanics. Rectangular tunnels have further advantages in revision cases, in which-in comparison with round tunnels-they have reduced overlap with pre-existing transtibial tunnels, increasing the chance of bypassing primary tunnels during revision surgery. Finally, instrumentation for minimally invasive QT harvesting has reduced technical difficulty and improved cosmetic results. Hence, technical and cosmetic concerns are no longer barriers to QT use. These anatomic and biomechanical advantages and technical developments make the QT an increasingly attractive option for both primary and revision ACL reconstruction.
| S-EPMC6203691 | biostudies-literature
Project description:Historically, one of the most common graft choices for anterior cruciate ligament (ACL) reconstruction in the pediatric population has been the hamstring autograft. Although pediatric ACL reconstructions with a hamstring autograft have allowed a majority of children and adolescents to return to athletics, it has been reported that anywhere between 6% and 38% of these patients will go on to experience subsequent graft rupture. The quadriceps tendon autograft is an alternative to the hamstring tendon autograft that demonstrates superior preliminary outcomes, and we currently recommend it for skeletally immature patients undergoing primary and revision ACL reconstruction. This paper aims to describe our technique for an open full-thickness quadriceps tendon harvest with repair.
| S-EPMC7587024 | biostudies-literature
Project description:Anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) was first described decades ago. Recent studies have demonstrated superior graft characteristics (diameter, strength, and stiffness) and reduced postoperative morbidity. However, limited instrumentation options currently available to surgeons allow for minimally invasive QT harvest with a bone plug. As an alternative to traditional QT harvest techniques, we describe a surgical technique allowing for minimally invasive QT autograft harvest with a bone plug (QuadVantage Technologies, Inc). This approach can offer technical advantages, including efficiency of graft harvest, reproducibility of procedure, and more consistent graft sizes.
| S-EPMC10714273 | biostudies-literature
Project description:The most commonly used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and hamstring tendons. Each has its advantages and limitations. The bone-patellar tendon-bone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.
| S-EPMC5020883 | biostudies-literature
Project description:All-inside anterior cruciate ligament reconstruction has recently gained popularity, in part because of its bone-sparing socket preparation and reported lower pain levels after surgery. However, because this technique uses suture loops and cortical suspension buttons for graft fixation, it has mostly been limited to looped graft constructs (e.g., hamstring autograft, peroneus longus allograft). Quadriceps tendon autograft offers several advantages in anterior cruciate ligament reconstruction but, until recently, has not been compatible with suture-loop and cortical suspensory fixation. We describe a technique that allows a relatively short (<75 mm) quadriceps tendon autograft (without bone block) to be used with established all-inside anatomic techniques.
| S-EPMC4887127 | biostudies-literature
Project description:Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft has long been considered the graft preference for young, active patients with anterior cruciate ligament injuries. The central-third of the native patellar tendon is a reliable graft and is the preferred option for competitive athletes given its excellent track record with high return-to-play rates and low failure rates. Disadvantages to using this graft include donor site morbidity and associated postoperative anterior knee pain, the risk of patellar fracture or patellar tendon tear, and the potential for graft-construct mismatch. In this Technical Note, we describe our preferred technique for bone-patellar tendon-bone autograft harvest and preparation for anterior cruciate ligament reconstruction.
| S-EPMC5621981 | biostudies-literature
Project description:Graft-tunnel mismatch (GTM) is a known technical challenge that can occur with anterior cruciate ligament reconstruction when using a patellar tendon autograft. Two-incision anterior cruciate ligament reconstruction is a well-established technique with excellent outcomes and can serve as an excellent tool to prevent GTM. Traditionally, 2-incision femoral tunnel drilling has been performed using an over-the-top guide through a lateral incision, but more modern retrograde reamer guides can allow this to be done percutaneously. We detail how a minimally invasive 2-incision femoral tunnel drilling technique can be used in patients with patellar tendon lengths that are longer than average to avoid GTM.
| S-EPMC11873465 | biostudies-literature