A Minimally Invasive and Simple Technique of Superficial Quadriceps Tendon Graft Harvesting

Revision Anterior Cruciate Ligament Reconstruction Using Rectus Femoris or Hamstring Tendon Shows Comparable Patient-Reported Outcome Measurements at Short-Term Follow-Up: A Retrospective Cohort Study

Background: The isolated rectus femoris tendon (RT) is a less commonly used autograft for anterior cruciate ligament (ACL) reconstruction. Graft selection is a critical part of ACL reconstruction, especially in revision surgery.

HYPOTHESIS

This study compares patient-reported outcome measurements (PROMs) between revision ACL reconstruction with an RT autograft and a hamstring tendon (HT) autograft. We hypothesized that the RT autograft will yield comparable functional results and high patient satisfaction.

STUDY DESIGN

This was a cohort study; the level of evidence is III. Methods: Fifty-five patients (RT n = 28; HT n = 27) who underwent revision ACL reconstruction were included in this study, with a mean follow-up time of 40.3 months (range, 16.4-64.8) for RT and 61.2 months (range, 34.6-86.3) for HT. Apart from the harvesting technique, the surgical technique was the same for both groups. Clinical and intraoperative data were collected for our postoperative registry. In addition, funcinal outcome was measured using the International Knee Documentation Committee score (IKDC), the Lysholm score, Tegner activity scale, and numeric rating scale (NRS). The type and frequency of postoperative complications were documented. Results: At the final follow-up, no significant differences were observed between the RT and HT groups in the IKDC (mean ± SD: 74.7 ± 10.9 vs. 74.9 ± 12.9), Lysholm score (90.9 ± 15.0 vs. 89.0 ± 14.6), or Tegner activity scale (median [IQR]: 5 [4-6] vs. 5 [4-6]). The mean femoral tunnel diameter was 9.0 mm (range, 7.5-10 mm) for the RT and 8.2 mm (range 7.0-9.5 mm) for the HT. The use of the RT reduced the need for a two-stage procedure by 50% compared to HT (n = 5 vs. n = 10), although this difference was not statistically significant (p = 0.11). Stability measured by the Lachman test improved significantly in both groups from the pre- to postoperative period. Retear of the ACL graft was observed in two patients in both groups (7.1% RT and 7.4% HT). Conclusions: The RT and HT autografts achieved similar outcomes in PROMs for revision ACL reconstruction. Good tendon quality with parallel fibers and adjustable thickness characterize the RT. A tendency for a reduced rate of two-stage surgery with RT was noticed.

CLINICAL RELEVANCE

The incidence of revision ACL reconstruction is rising. Surgeons should be aware of all the available graft options. The isolated RT expands the range of autografts available for ACL reconstruction.

Combined Anterior Cruciate Ligament and Anteromedial Oblique Ligament Reconstruction Using the Rectus Femoris Tendon: Description of Surgical Technique

We present a technique for combined anterior cruciate ligament and anteromedial oblique ligament reconstruction using the rectus femoris tendon graft. Anatomic anterior cruciate ligament reconstruction and anteromedial reinforcement are performed with a single rectus femoris graft. The rectus femoris tendon graft is harvested in a reproducible and minimally invasive approach. The surgical technique requires no special instruments and consists of 3 bone tunnels. Fixation is performed with interference screws.

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using the Superficial Layer Quadriceps Tendon Graft: Surgical Technique Description

We present a technique for the combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction using the superficial layer quadriceps tendon graft. Anatomic reconstruction is achieved with outside-in femoral tunnel drilling. The femoral drill guide has an intra-articular placement at the femoral footprint of the ACL and an extra-articular placement at the femoral ALL attachment. This surgical technique does not need any special instruments and consists of 3 bone tunnels. The long length and customized superficial quadriceps tendon graft is harvested in a minimally invasive manner and allows an accessible and low-cost reconstruction of both ligaments.

Minimal invasive medial patellofemoral ligament reconstruction using quadriceps tendon with de novo technique and arthroscopic guided: A case report

INTRODUCTION

Medial Patellofemoral ligament (MPFL) reconstruction, the primary procedure for restoring patellar stability and preventing further dislocation, has seen numerous methods and grafts. However, a consensus on the technique and graft remains elusive. This study introduces a novel approach to MPFL reconstruction, utilizing a unique combination of minimal invasiveness, de novo method, and arthroscopic guidance to harvest a quadriceps tendon (QT) graft without the need for a harvesting tool.

CASE ILLUSTRATION

A 37-year-old female presented to the emergency room with the chief complaints of left knee pain and swelling following the third spontaneous dislocation of the patella. The patient had a few episodes of locking sensation and instability of the left knee while walking, especially while climbing stairs. A knee MRI revealed MPFL tear in the left knee. A modified minimal invasive MPFL reconstruction technique was performed. The IKDC, Lysholm, and Modified Cincinnati scores improved significantly from preoperatively 48.3 %, 49 %, and 51 % to 89.7 %, 90 %, and 95 % consecutively. No recurrent patellar dislocations or swelling were reported during follow-up.

DISCUSSION

While quadriceps graft harvesting for MPFL reconstruction is typically highly invasive, using quadriceps tendons has consistently shown excellent outcomes. This study, however, takes it a step further by demonstrating that a minimally invasive procedure for harvesting quadriceps tendons, even without specialized instrumentation, can also yield excellent results.

CONCLUSION

MPFL reconstruction using superficial quadriceps tendon autograft can be achieved using a minimally invasive technique without the use of specialized instrumentation and has shown excellent knee functional improvement.

The Use of a Simple Vaginal Speculum to Harvest Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction and Avoid Any Potential Pitfalls during Harvesting Procedure: Technical note

This technical note aimed to present a straigthforward method for harvesting quadriceps tendon autografts with the use of a simple vaginal speculum and direct visualisation of a scope. Anterior cruciate ligament reconstruction with quadriceps tendon autografts has gained popularity in recent years, with many harvesting techniques that use different harvesting systems available on the market. These techniques vary from transverse to longitudinal skin incisions and from open to minimally invasive approaches and have a learning curve, as with the majority of surgical procedures. The technique proposed in this technical note is minimally invasive, can be easily reproduced by any surgeon irrespective of their experience, has a short learning curve, requires no additional cost or technical support during the procedure and creates a stable working space that allows for freedom of manipulation of surgical instruments and the arthroscope.

Harvesting the Quadriceps Tendon With a Minimally Invasive Approach

Background

This article describes a standardized, minimally invasive approach for harvesting the quadriceps tendon through a 2 to 3 cm transverse skin incision, presenting it as a viable option.

Indications

This procedure is indicated for patients undergoing anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, or lateral collateral ligament reconstruction surgery using soft tissue quadriceps grafts.

Technique Description

A transverse incision is made on the anterior face of the knee, followed by a longitudinal incision of the central third of the rectus femoris. We perform the distal detachment of the patella of the same tendon. Then, the tendon is extracted using a closed stripper. The graft is prepared and folded on itself, resulting in a double graft.

Results

Twenty patients, 16 male and 4 female with complete rupture of ACL, were submitted to an ACL reconstruction using the quadriceps soft tissue graft with minimally invasive harvesting technique. The results were satisfactory for all patients. All patients showed good evolution in the immediate and late postoperative period, with no cases of joint stiffness, wound dehiscence, and no infections.

Discussion/Conclusion

We can conclude that harvesting the quadriceps tendon with a minimally invasive approach is a valid and reliable option for the treatment of ligament tears of the knee.

Patient Consent Disclosure Statement

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

Quad Tendon Autograft for Posterior Cruciate Ligament Reconstruction Using Transseptal and Posteromedial Portals

We describe a surgical technique for reconstruction of the posterior cruciate ligament with quad tendon autograft using transseptal portal. We place the guide for the tibial socket through the posteromedial portal instead of transnotch, which is the most common practice. The use of the transseptal portal allows good visualization during the drilling of the tibial socket to protect the neurovascular bundle while avoiding the use of fluoroscopy. The advantage of using the posteromedial approach is the easy placement of the drill guide and to option to pull the graft once through the posteromedial portal and a second time through the notch, which helps passing the "killer turn." The quad tendon is harvested with a bone block that is placed in the tibial socket and fixed with screws in the tibial and femoral side.