ACL reconstruction: quadriceps tendon

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Wybren van der Wal bergman gelderse vallei

Co-written by dr. Wybren van der Wal

Michael de Levie fysio en kniespecialist

Written by Michael de Levie

August 30, 2023

There are four different tendons an orthopedic surgeon can choose from to restore knee stability during anterior cruciate ligament surgery. The four tendons are: quadriceps tendon, patella tendon, hamstring tendon and donor tendon. This blog is about the quadriceps tendon. We will discuss what a quadriceps tendon is and the advantages and disadvantages of this tendon. 

All about the quadriceps tendon as an anterior cruciate ligament

Every year in the Netherlands, about nine thousand people undergo anterior cruciate ligament reconstruction. A tendon that will function as a cruciate ligament is used to make a new one. There are several options for this. The tendon used to make a cruciate ligament from is called a "graft" in medical jargon. Which tendon your anterior cruciate ligament will be made from is useful to know. In this blog, you'll read about the factors the orthopedic surgeon uses to choose your graft and the differences between grafts.

Michael de Levie and Wybren van der Wal Orthopedic surgeon at hospital the Gelderse Vallei in Ede.

What is an anterior cruciate ligament?

The ACL is a Dynamic structure, rich in neurovascular supply and comprised of distinct bundles, which function synergistically to facilitate normal knee kinematics in concert with bony morphology. Characterized by individual uniqueness, the ACL is inherently subject to both anatomic and morphological variations as well as physiologic aging. 

– Freddie Fu –

voorste kruisband-anatomie

What is a quadriceps tendon

Relative to the patellar tendon, the quadriceps tendon sits at the top of the kneecap. The difference with the kneecap tendon is that it has a bone block on one side. This, like the patellar tendon, has the advantage of growing into place faster. However, the quadriceps tendon can also be gained without a bone piece. The quadriceps is a strong and thick tendon and therefore suitable as a graft for anterior cruciate ligament reconstruction.

Advantage quadriceps tendon

The patellar tendon technique usually produces pain at the front of the knee to a greater or lesser degree. The hamstring technique is an alternative in this regard. But the hamstring is also the muscle that inhibits the forward displacement of the lower leg and thus supports the function of the anterior cruciate ligament. Compared to the quadriceps, the hamstrings are naturally less powerful muscles. The idea behind using the quadriceps tendon is to prevent pain at the front of the knee (patellar tendon) and maintain hamstring function. Another advantage is that the quadriceps tendon is easy to gain. In addition, it is a strong and thick tendon.

Disadvantage quadriceps tendon

The disadvantage of the quadriceps technique is that the quadriceps muscle is affected by the removal of part of the tendon. Recovery of control and strength requires more time because of this. Flexion also usually needs more time and attention to recover. Because of both factors, rehabilitation generally takes longer and recovery takes relatively longer. A cosmetic drawback may be reduced healing of the skin. Because of the pulling forces on the wound, the scar may not recover as nicely. In conclusion, the use of the quadriceps tendon is a fairly new technique. Because of this, few long-term effects are yet known.

Benefits include:
  1. The tendon can be extracted with unilateral bone block or without. 
  2. Lower risk of kneecap injuries.
  3. Hamstring strength is not affected.
  4. A good and safe tendon to extract. 
  5. A strong, thick and tensile tendon. 
Disadvantages are:
  1. Prolonged rehabilitation due to impaired quadriceps strength building. 
  2. Prolonged stiffness of the knee on bending.
  3. There is a chance that the scar may not recover as nicely.
  4. Fairly new technology, there are few long-term effects known.
Quadricepspees voorste kruisband

Extracting the quadriceps tendon

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