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Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often
  1. Andrew J Sheean1,
  2. Volker Musahl1,
  3. Harris S Slone2,
  4. John W Xerogeanes3,
  5. Danko Milinkovic4,
  6. Christian Fink5,
  7. Christian Hoser5
  8. International Quadriceps Tendon Interest Group
    1. 1Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    2. 2Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
    3. 3Emory Clinic, Atlanta, Georgia, USA
    4. 4Universitatsklinikum Munster, Klinik fur Unfall-Hand-und Wiederherstellungschirurgie Munster, Munster, Nordrhein-Westfalen, Germany
    5. 5Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University UMIT, Innsbruck, Austria
    1. Correspondence to Dr Andrew J Sheean, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh PA 15203, USA; ajsheean{at}


    Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon’s armamentarium.

    • arthroscopic surgery
    • ACL
    • knee injuries
    • quadriceps

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    • Contributors AJS, VM, DM and HSS contributed directly to the writing of the manuscript. CH, JWX and CF offered critical reviews of the manuscript and participated in the editing process.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests LE is a member of the International Quadriceps Tendon Interest Group, and he was not part of the peer review process. The authors report the following conflicts of interest or sources of funding: JWX reports grants, personal fees and non-financial support from Arthrex during the conduct of the study; grants from Arthrex, outside the submitted work. The remaining authors have no disclosures relevant to the publication of this review.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators International Quadriceps Tendon Interest Group: Andrew J Sheean, Volker Musahl, Harris Slone, John Xerogeanes, Danko Milinkovic, Christian Hoser, Christian Fink, Jon Karlsson, Lars Engebretsen, Marie Askenberger, Karl Peter Benedetto, Myun Chun Lee, Peter Fauno, Freddie H Fu, James J Irrgang, Andrew Lynch, John P Fulkerson, Hege Grindem, Mirco Herbot, Juergen Hoeher, Martin Lind, Wolf Petersen, Robert Steensen, Jacob Strauss.