Histologically it has 20% more collagen fibrils per cross-sectional area than the patellar tendon (PT). Wright RW, Haas AK, et al. To find a suitable alternative, Dr. Albright conducted a lengthy review of literature on the grafts used for ACL reconstruction in adults. S.S: My preference in young patients is to use autograft.Many recent studies, including the recent MOON studies, have demonstrated that autograft is superior to allograft, with significantly decreased risk of re-rupture, in a young athletic population.The risk of re-rupture approaches equal at about age 35. Biomechanical and cadaveric studies have found that the CSA of the native ACL is 44 mm 2. These tendons are then doubled over, resulting in a 4 stranded graft. An alternative graft for ACL reconstruction. There can be some residual numbness along the anterolateral aspect of the knee due to the incision cutting some small, superficial sensory nerve fibers. Anatomically the quadriceps tendon has significantly more … It allows surgeons to safely harvest a graft of a desired length and diameter through a small incision in a … 50(24): 1506-1515. In addition, despite the variability in quadriceps tendon morphology, a graft of consistent length (7 to 8 cm), depth (6 to 7 mm), and width (9 to 10 mm) can be harvested with careful surgical technique without violation of the suprapatellar pouch. The first choice is deciding whether the graft is harvested from the patient (autograft) or harvested from a cadaver (allograft). However, in older patients (over the age of 55), an allograft may be considered. The average age at the time of surgery was 16 years. The quadriceps tendon is a thick, robust tendon above the patella (kneecap). © 2021 Arthrex, Inc. All rights reserved. Numerous orthopedic studies support the quad tendon graft technique in comparison to both patellar tendon and hamstring tendon autografts for ACL reconstruction. A larger incision along the anterior aspect of the knee is required to harvest this graft compared to a quad harvest. With these cookies, we can count visits and identify traffic sources to help us determine and improve the performance of our site. A hinged knee brace is used to support the leg until the musculature can support the knee. They help us identify which pages are the most popular, which are the least used, and how visitors move around the site. It is the most common option for reconstruction in skeletally immature children to minimize the risk of growth plate arrest. The quadriceps tendon as an ACL graft has been used for quite some time, but has gained more popularity over the last 5 years as another excellent option. Anterior cruciate ligament reconstruction with quadriceps tendon autograft is a great autograft option for many patients. F: 970-668-5052 108 South Frontage Road West These cookies are necessary for the functioning of our website and cannot be deactivated in our systems. Vail, CO 81657 The free ends of the Fig 2. It allows surgeons to safely harvest a graft of a desired length and diameter through a small incision in a time-efficient manner. Torn ACL – Quadriceps Tendon Graft The anterior cruciate ligament (ACL) is one of four ligaments that are crucial to the stability of your knee. Mobile Directions, 360 Peak One Drive Initially, PT is focused on restoring knee range of motion and reducing swelling. The results of ACL reconstruction with a hamstring graft are good. Harvesting techniques for acl for return to the quad tendon graft. Dr. Cunningham utilizes primarily quad tendon in his practice. A partial or complete tear of your ACL will cause your knee to become less stable and feel as though your knee is about to give out. Mobile Directions, Best ACL Graft for a Professional Athlete, High success rate compared to all other graft options, Very low reinjury rates compared to hamstring grafts, Thickest, strongest graft option. 6. Edwards, CO 81632 There are also techniques to create a 5 or 6 stranded hamstring graft. Getting the quads to fire again after taking a piece of the quad tendon out, is so difficult as I later found out. Melick et al. F: 970-479-9166 This may cause some areas of the site not to work. a carpenter), a patellar tendon would be discouraged given the higher incidence of kneeling pain with this graft choice. Honestly, the more I researched this graft option, the more I consider this a truly viable choice. Risberg, M. A, Lewek, M., Synder-Mackler, L. … A patient will remain in the post-operative knee brace until they are able to achieve acceptable quadriceps activation and control which typically takes 2-3 weeks. However, recent literature has shown that these grafts have some disadvantages. At week 8 focus on single leg squat, and other single leg closed kinetic chain activities. Sports Health 2015 7(3): 239-243. An ACL reconstruction using hamstring tendon autograft involves the surgeon using one or two of the hamstring tendons on the medial (side closest to the midline) side of the knee. People can warn you and tell you, but you never really know until you are experiencing it. The typical graft size was 9 mm x 9 mm x 75 mm. Several factors will affect the choice of which graft to use, particularly patient age and activity level. There is a light at the end of the tunnel! Coupled with a high rate of success with ACL reconstruction using a quad tendon graft, the benefits of a quad tendon harvest are: For ACL surgery patients, the quadriceps tendon graft is a good alternative with distinct biomechanical and recovery advantages. Autograft tendon choices for ACL Reconstruction include: Anterior cruciate ligament reconstruction with quadriceps tendon autograft is a great autograft option for many patients. There are many benefits of a quad autograft including: Hamstring tendon autograft for ACL reconstruction is completed by harvesting the patient’s semitendinosis and gracilis tendons. Patients can ride a bike outdoors at 3 months and start running at 4 months. For over a decade, the ACL Doctor, Dr. Richard Cunningham, has utilized the quadriceps tendon for ACL reconstruction almost exclusively in his practice. The most common complaint with bone-patellar tendon-bone grafts is pain along the front of the knee with kneeling and this pain may be permanent. Female athletes and athletes under the age of 25 are prime candidates for quad tendon graft ACL reconstruction. Your language settings, for example, are stored as functional cookies. Graft options for ACL surgery has its own risks and benefits. ACL REHAB PROTOCOL (Patellar/Quad Tendon Graft) ... ACL rehab protocol **Return to sport/work is dependent on passing of functional testing and sign off ... Progress quad, hamstring, calf, hip strengthening SL Bridge Single leg knee bends 30°-60° range and progress to tubing Results: From June 2010 to March 2015, 25 ACL reconstructions using quadriceps tendon autografts were performed by the senior author. The system has the versatility to create grafts to meet the surgeons' needs whether it be all soft tissue, bone soft tissue, all-inside or transtibial. Start closed kinetic progressions in inclined machines or with low loads at week 6, but no squatting or leg press past 90 . Autogenous quadriceps tendon-bone graft is a great choice for knee reconstruction procedures, including primary and revision reconstructions of both anterior cruciate ligament (ACL) and posterior cruciate ligament. There was an error retrieving the content. (2016). The Minimally Invasive Quad Tendon Harvest System was designed based on published anatomic studies. Patients are instructed to ice and elevate the knee for the first few days after surgery, but physical therapy is started immediately after surgery. 5. These cookies enable the provision of advanced functionality and customization. Quad Tendon Graft Preparation Using the FiberTag, Minimally Invasive Quadriceps Tendon Harvest for ACL Reconstruction, Minimally Invasive Bone Quad Tendon (BQT) Graft Harvest for All-Inside ACL Reconstruction, QuadLink™ Graft Preparation With the FiberTag, Second Look: Bone Quad Tendon (BQT) QuadLink™, Quadriceps Tendon (QT) ACL Reconstruction Scientific Update. The graft has an initially more difficult recovery because your quad muscles are the most important to full recovery after ACL reconstruction. 84 You can revoke this consent at any time and delete the cookies at any time. These include the patient’s age, patient sex, activity level, lifestyle, and post-surgical expectations. You can set your browser to block these cookies or to notify you about these cookies. Please try again, or try refreshing the page. Certain products may not be approved for sale in all countries. When you are ready to submit your request, simply click the "View Cart" button (5) or alternatively the "Cart Overview" button (4). However, there may be prolonged hamstring weakness. Fracture and Orthopaedic Clinic, located in Trinidad and Tobago, is one of the Caribbean's leading specialty clinics providing a complete range of orthopaedic services. The Anterior Cruciate Ligament (ACL) provides anterior and rotational support to the knee. This website uses its own cookies and cookies from analytical services to provide its services, personalize advertisements, and analyze traffic. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. He landed on the quadriceps graft — a piece of bone from the kneecap along with the attaching tendon. a lower incidence of patella fracture than a patellar tendon graft), Flexibility on determining graft length that is required during the harvest. Br J Sports Med. 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. For more information about the third-party vendors we work with, read the section "Data collection when visiting our website" in our Data Privacy Statement. Quadriceps Graft Gaining Acceptance. Performance cookies may be set by us or third parties whose services we use on our sites. Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries. This graft is typically 7 … In addition to PT, patients will also do a home exercise program, to maximize the rehabilitation timeline. Historically, the patellar tendon graft has been the most widely used graft of choice, … Quadriceps Tendon Autograft Another autologous graft option, which I feel is underutilized, is harvesting a quadriceps tendon autograft to reconstruct the ACL. Suite 180 Therefore, in the last decade, autografts have been more frequently used, as they yield better results compared to an allograft. The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity. Twice the cross-sectional area of a patellar tendon graft, Equal success rate to patellar tendon, but with a lower incidence of kneeling pain and a smaller incision, Excellent results for athletes who do high demand sports and activities, No bone plug required compared to patella tendon graft, Minimally invasive incision over the harvest site, Thicker graft, and greater cross-sectional area, Reduced complications (ie. By agreeing to the use of these cookies, you also consent to processing by the cookies. If you do not allow these cookies, we will not know when you visited our website. 14 males and 10 females were studied. So, when we fix an ACL, we actually have to take out the old ACL and put something new in to replace it. In the past, many surgeons utilized allografts for most patients undergoing ACL reconstruction, but these were found to fail at a higher rate. ACL WITH QUAD TENDON AUTOGRAFT PHASE I (0-3 WEEKS) DATES: Appointments • Physical therapy 2 -3x/week, beginning 2 5 days post op Rehabilitation Goals • Full extension symmetrical to contralateral knee before the first post-op visit at 2 weeks • Flexion to 120° • 20° SLR without quad lag • Off of crutches Precautions • WB: This is definitely a “niche” graft because it is only used in a small percentage of patients worldwide. The Minimally Invasive Quad Tendon Harvest System was designed based on published anatomic studies. For over a decade, the ACL Doctor, Dr. Richard Cunningham, has utilized the quadriceps tendon for ACL reconstruction almost exclusively in his practice. Patients can remove their dressings and take a shower over the wound sites 3 days after surgery. Patient compliance during the recovery process will help ensure complete healing and an optimal outcome. F: 970-569-3260 In addition, there is a higher incidence of hamstring graft stretching or retears. JOSPT 2012 42(3): 153-171. Mobile Directions, 1140 Edwards Village II Good clinical results for both grafts have been reported in the literature [ 3 ]. The quad graft is the strongest graft as demonstrated in several studies, stronger than hamstring or patellar tendon. P: 970-668-3633 After reviewing the cart details, click the "Submit Request" button to finalize and submit your request. More And More Athletes Are Opting To Use The Quad Tendon Graft In Reconstructing The ACL. The two most common graft options use either two of the hamstring tendons or a part of the patella (a fancy word for knee) tendon. With a hamstring graft, most ACL surgeons are doubling over both the semitendinosus and the gracilis tendon to create a graft comprised of 4 strands of tendon. The other autograft that can be used for ACL reconstruction is a quadriceps autograft. Patella tendon autograft for ACL reconstruction is completed by taking the middle one-third of the patella tendon along with a one inch long bone plug taken from the patella and another bone plug taken from the tibia and left attached to each end of the tendon. At 6 weeks from surgery, some gentle quad strengthening is begun. ACL Reconstruction Using Quadriceps Tendon Autograft Criterion Based Postoperative ACL Quadriceps Tendon Reconstruction Rehabilitation *Because this procedure only requires harvest of a portion of the quadriceps tendon rehabilitation can begin with minimal soft tissue limitations. R. Lee Murphy Jr., MD provides d technique guidance for the use of the quad tendon graft for ACL reconstruction. I’m 3 months and 2 weeks post op (ACL reconstruction with quad tendon graft) and my quad is finally starting to come back with some definition. P: 970-569-3240 Outpatient Physical therapy is prescribed with patients going 2-3 days per week immediately after surgery. Frisco, CO 80443 Another way for 6-strand graft preparation is to use a 4-strand graft with 1 tendon and load another tendon as a 2-strand graft or to use 2 suspensory devices for an all-inside ACL reconstruction.17 Eight-Strand Graft Preparation With Two Tendons (GC and ST). This graft utilize Which ACL graft Would You Choose to Reconstruct the ACL of an 18 year old Athlete? Suite 206 There are several factors that may impact the graft choice. Start ACL protocol combining Phase 1 and 2. Newer graft harvest techniques and instrumentation has allowed for easy, safe, and reliable graft size harvesting. In the young (< 35 years old), active patient cohort, there is strong evidence to support the use of an autograft for ACL reconstruction. Quadricep tendon grafts offer unique benefits for cruciate ligament reconstruction such as a predictably large diameter, low morbidity and a preferable stiffness profile for knee ligament reconstruction. This graft has historically been used in young athletes who compete in high level cutting and pivoting sports as well as in professional athletes with good results. At Children's Colorado, we also offer a third option, called the quadriceps tendon autograft (also called the quad-tendon graft for short). Hamstring grafts are popular due to a slightly smaller incision off to the side of the knee instead of the front of the knee.
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