1. The Quadriceps Tendon: The Forgotten graft?
Systematic Review of
Primary ACL Reconstruction utilising
Autograft Quadriceps Tendon
S Hutchinson, J Mulford

2. Quadriceps tendon had increased interest in recent times as a graft for primary ACL surgery.
We wanted to know the outcomes utilising this graft when compared to traditional autografts

3. Technique

4. Aim
Clarify the outcomes with use of the quadriceps tendon in primary ACL surgery.
Systematic review process was utilised.

5. Proposed Benefits of Quads Graft
Thicker tendon cf patella tendon
Ability to be consistently used as a double bundle graft
Provides bone healing on one side
Less anterior knee pain cf patella tendon
Less stretching cf hamstring tendon

6. Method
A search process utilising: MEDLINE ( ), EMBASE ( ), CINAHL, Google search engine.
Review of references of all articles identified in the search.

7. Inclusion and Exclusion Criteria
Inclusion criteria
1. Original articles with patients with primary ACL rupture treated with a quadriceps tendon autograft.
2. Articles which reported on one or more of the primary outcomes.
Exclusion Criteria
1. Articles which did not document minimum length of patient follow-up.
2. Studies with less than 12 months of patient follow-up.
3. Duplicate publication of any type, for example abstracts, comments, review or technique articles, duplicate reports and articles based on preliminary data from larger series.

8. Pre Determined Outcomes
Subjective
Anterior/patellofemoral/ kneeling pain
patient satisfaction.
Objective
Range of motion (flexion loss or extension loss > 5 degrees)
Lachman Grade, pivot shift grade
IKDC score
KT-1000
return to pre-injury level,
muscle strength (flexion and extension strength),
Lysholm score
surgery complications (Specifically graft rupture or failure, patella fracture and infection).

9. Data extracted independently by two reviewers
Recorded
Methodology
predetermined outcome measures

10. Results Initial search identified 45 article for review
16 articles met the inclusion criteria
4 articles compared graft types
3 patella tendon vs QT; 1 hamstrings

11. Comparison Articles 3 compared PT to Quads 1 compared Quads to HT
Poor methodology and variability in reporting of outcomes
No real difference except
Anterior Knee Pain
43 of 114 (38%) in patella tendon
12 of 108 (11%) in quadriceps group

12. All Articles
All retrospective studies
1539 grafts

13. Subjective Outcomes Patient satisfaction: 91% (303 of 332)
Anterior knee pain: 3% (22 of 699)

14. Objective Outcomes Lachmann grade >1: 7% (52 of 684)
Pivot Shift grade > 1: 8% (41 of 534)
IKDC score A or B: % (592 of 676)
Lysholm Score: Acceptable post op outcomes (89-94)
Fixed flexion > 5 degrees % (27 of 730)
Quads strength (<80%): of 398

15. Complications
Graft failure: % (21 of 666)
Patella fracture: 5

16. Conclusion
The quadriceps tendon is a viable alternative to traditional autografts.
Anterior knee pain is less for quadriceps graft compared to patella tendon grafts.
Thus our goal to set up a randomised trial

17. Stephen Hutchinson Jonathan Mulford
Thankyou
Stephen Hutchinson
Jonathan Mulford