Is a Quadriceps Tendon Autograft the Best Form of ACL Reconstructive Surgery?

While there are several surgical approaches to this procedure, one has become increasingly popular in recent years and is known as the quadriceps tendon autograft.

In this article, we’ll address how the graft works, what patients can expect from their procedure, and how it compares to other forms of ACL reconstructive surgeries.

High-impact sports can take their toll on our bodies. As one of the key supportive tendons in our bodies, the ACL allows for dynamic movement in our legs, supporting our weight as we pivot, run, and jump, keeping our legs mobile and flexible.

Despite its integrity, the ACL can be susceptible to injury, especially with intense physical activity and stress. The more pressure applied to the tendon, the more wear and tear it endures, increasing the risk of injury.

While most common among athletes, several scenarios can result in an ACL tear:

• Blunt trauma to the knee
• Overextension
• Pivoting/stopping while in motion
• Jumping

Many patients who tear their ACL will hear or feel a sudden “pop” in their knee. Shortly after, the tissues around the joint will begin to swell, resulting in extreme pain and discomfort.

In these cases, individuals with a torn ACL will struggle to walk, unable to control the movements in their leg without experiencing extreme pain. 

As one of the most feared sports injuries, ACL injuries can require months of recovery and physical therapy before the ligament begins to heal. The ACL is unlikely to heal on its own and will require surgery—without the proper treatment, such an injury can be devastating, preventing some athletes from returning to the field for the remainder of their careers.

The quadriceps tendon autograft is a surgical technique that involves harvesting a strip of the quadriceps tendon to replace the ACL. This graft can be taken with or without an attached bone plug from the patella (located along the knee joint). Taken from the knee, the quadriceps tendon is the thick, connective tissue that joins the quadriceps muscles to the kneecap.

Compared to other types of grafts, the quadriceps tendon autograft offers several advantages. First, due to the tendon’s strength, it provides greater resistance against forces on the knee during physical activity, including pivoting, cutting, and jumping. Second, the procedure itself is less invasive—the incision made to harvest the graft covers less surface area than those required for other types of grafts, limiting damage to the surrounding tissue. Finally, since the graft comes from the patient’s own body, there’s less risk of rejection or infection.

During the procedure, the surgeon will cut a small incision along the patient’s knee to extract the graft tendon. They will then detach the tendon from its insertion, cutting an appropriate length for the graft without compromising the original connection. The graft is then prepared by placing a suture through the ends of the tendon, ensuring a strong connection when attached.

Next, the surgeon will remove the torn ACL from the knee using a motorized shaver to resurface the area. A small hole will then be made where the ACL connects to the femur and another device will create a channel for the button.

The lead sutures for the side that’s going into the femur are then drawn into the joint, and the metal button is pulled through the channel. The surgeon ensures the suture is placed correctly on the cortex by pulling on the two connection points—as the loop closes, the surgeon then brings the graft toward the button. As it pulls through, the connection will be complete, fixing in place a replacement tendon that can serve as your ACL.

For many patients, the procedure offers the flexibility and resilience that can allow them to return to normal activities, decreasing the odds of a recurring injury. Safe and effective, the procedure offers long-lasting benefits for a majority of patients—in fact, the surgery has a nearly 96% success rate among patients in their 20s, with fewer than 4% experiencing complications. 

The quadriceps tendon autograft is also a surgical technique that can offer several advantages over other types of ACL grafts. 

Out of patients who received ACL reconstruction surgery, a quadriceps tendon autograft was shown to be more resilient, stronger, and could absorb greater impacts over time without wearing out.

The procedure itself is also less invasive—since it uses one of your own tendons, your body is also less likely to reject the transplant, presenting a lower risk of infection.

While the surgery is complex, under the supervision of the right surgeon, it can be a life-changing treatment option for anyone with an ACL injury who is looking to return to normal activities.

ACL reconstructive surgery is a delicate procedure that requires deep surgical knowledge and experience to perform correctly. 

Randy S. Schwartzberg, M.D., a board-certified orthopaedic surgeon at Orlando Orthopaedic Center, has years of experience helping patients recover from debilitating sports injuries. With an extensive background in treating ACL tears, Dr. Schwartzberg understands just how frustrating an ACL tear can be—for his patients, the procedure is often life-changing, offering a second chance for an injury that in the past has ended many professional athletes’ careers. 

As an expert in ACL reconstructive surgery, Dr. Schwartzberg regularly performs quadriceps tendon autografts, possessing the skill and knowledge to help patients with ACL injuries get back to doing what they love.