Central Quadriceps Free Tendon Harvest for Anterior Cruciate Ligament Reconstruction

Chapter 75


Central Quadriceps Free Tendon Harvest for Anterior Cruciate Ligament Reconstruction








Central quadriceps free tendon (CQFT) graft reconstruction of the anterior cruciate ligament (ACL) has been refined from earlier descriptions of the procedure using a bone block from the proximal patella in quadriceps tendon for ACL reconstruction. Quadriceps free tendon (without bone) reduces the morbidity of graft harvest and provides a substantial free tendon autograft for ACL reconstruction, saving both time and morbidity.1,4 The CQFT is an important and desirable autograft alternative for ACL reconstruction. It is harvested from a large tendon donor site without neurovascular complication risk and without risk of patellar fracture.



Preoperative Considerations


I use central quadriceps tendon for reconstruction in virtually all patients—male and female, competitive athletes and working people. My criteria for surgery, elicited in the history, include recurrent instability related to ACL deficiency that limits daily function or participation in desired athletic activity and an active athletic lifestyle requiring quick turning, pivoting, and cutting such that problems might be predictable without ACL reconstruction. I establish a loss of ACL function by clinical examination to detect positive Lachman and pivot shift test results. I routinely use magnetic resonance imaging for confirmation.


Contraindications include gross obesity, sedentary lifestyle in which ACL reconstruction may not be necessary, immunosuppressive therapy, and smoking on a regular basis. I find that most smokers are willing to give up smoking during the preoperative and postoperative period to allow graft healing. Small women (under 5 feet tall) may have a short quadriceps tendon. Even in such patients, an adequate graft can be harvested. No quadriceps tendon rupture has occurred in any of my patients.



Surgical Technique


Box 75-1 outlines the specific steps of this procedure.



Box 75-1   Surgical Steps




1. Make incision.


2. Define and make incision for medial and lateral borders of graft to 7 mm thickness.


3. Define posterior portion of graft by spreading with a hemostat.


4. Release graft from the proximal patella.


5. Grasp distal end of graft with uterine T clamp and whipstitch end.


6. Release quadriceps free tendon graft proximally to obtain a 7- to 8-cm-long, 7-mm-thick free tendon graft for anterior cruciate ligament reconstruction.


7. Prepare the quadriceps free tendon graft on a suitable holding platform; make double whipstitches in both ends.


8. Use EndoButton on the proximal end of the graft for femoral fixation, placing one front and one back suture of graft through central holes of the EndoButton. Tie knot adjacent to graft to meeting ends of sutures.


9. Secure the tibial side with a biointerference screw or a button tied at the tibial exit site.

Related posts:

Open Repair of Posterior Shoulder Instability Osteochondral Autograft for Cartilage Lesions of the Knee Arthroscopic Rotator Cuff Repair: Double-Row Techniques Surgical Treatment of Posterolateral Instability of the Elbow Primary Repair of Osteochondritis Dissecans in the Knee Arthroscopic Meniscus Repair: All-Inside Technique

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Sep 11, 2016 | Posted by in SPORT MEDICINE | Comments Off on Central Quadriceps Free Tendon Harvest for Anterior Cruciate Ligament Reconstruction

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