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Full thickness quadriceps tendon grafts with bone had similar material properties to bone-patellar tendon-bone and a four-strand semitendinosus grafts: a biomechanical study

Abstract

Purpose

Despite increasing interest in utilizing quadriceps tendon (QT) grafts in anterior cruciate ligament reconstruction (ACLR), data on the optimal quadriceps graft thickness are limited. The purpose of this study was to characterize the mechanical properties for the quadriceps tendon, comparing full-thickness (FT) QT grafts with and without bone to a partial-thickness (PT) QT graft, and comparing the three QT grafts to four-stranded semitendinosus (4-SST) and bone-patellar tendon-bone (BTB) grafts and one experimental graft, the two-stranded rectus femoris (RF).

Methods

Forty-eight (n = 48) young cadaveric grafts (mean age 32 ± 6 years) were utilized for testing with N = 8 specimens in each of the following groups; (1) FT QT with bone, (2) FT QT without bone, (3) PT QT without bone, (4) BTB, (5) RF, and (6) 4-SST. Each specimen was harvested and rigidly fixed in custom clamps to a dynamic tensile testing machine for biomechanical evaluation. Graft ultimate load and stiffness were recorded. Independent groups one-factor ANOVAs and Tukey’s pairwise comparisons were performed for statistical analyses.

Results

FT QT with bone and 4-SST grafts demonstrated similar ultimate loads to BTB grafts (both n.s), whereas PT QT demonstrate statistically significantly lower ultimate loads to BTB grafts (n.s) and 4-SST grafts (n.s). Furthermore, no statistically significant differences were observed between the ultimate loads of FT QT vs. PT QT grafts without bone (n.s) or between FT QT with vs. without bone (n.s). FT QT grafts with bone did not demonstrate statistically significantly greater ultimate loads than PT QT grafts without bone (n.s). The RF graft demonstrated statistically significantly lower ultimate loads to BTB grafts (p < 0.005) and 4-SST grafts (p < 0.014).

Conclusions

Full thickness QT grafts with bone had similar material properties to BTB and a 4-SST grafts, while Partial thickness QT graft without bone had significantly lower material properties than BTB and 4-SST, in a biomechanical setting.

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Funding

This study was funded by Smith & Nephew.

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Correspondence to Marc J. Strauss.

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Conflicts of interest

Dr. Marc Strauss is a paid for educational consultant for Smith and Nephew and receives research grants from Smith and Nephew. Dr. Martin Lind is a paid for educational consultant for Smith and Nephew. Receives research grants from Smith and Nephew and is on the Editorial Boards of KSSTA and JEO. Dr. Gilbert Moatshe is a paid for educational consultant for Smith and Nephew. Dr. Lars Engebretsen is a paid for consultant for Arthrex and Smith and Nephew. Receives royalties from Arthrex, and research grants from Ossur, Biomet, and Smith and Nephew. Is on the Editorial Boards of AJSM, KSSTA and JEO. Is an editor for JBJS and BJSM. Dr. Robert LaPrade is a paid for consultant for Arthrex, Ossur, Linvatec and Smith and Nephew. Recieves royalties from Arthrex, Ossur, Elsevier and Smith and Nephew and research grants from Ossur and Smith and Nephew. Is on the Editorial Boards of AJSM, KSSTA and JEO. Authors John Miles, Grant Dornan and Mitchell declare that they have no conflicts of interest.

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Strauss, M.J., Miles, J.W., Kennedy, M.L. et al. Full thickness quadriceps tendon grafts with bone had similar material properties to bone-patellar tendon-bone and a four-strand semitendinosus grafts: a biomechanical study. Knee Surg Sports Traumatol Arthrosc (2021). https://doi.org/10.1007/s00167-021-06738-x

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Keywords

  • Knee ligament
  • ACL
  • ACL reconstruction
  • Quadriceps tendon
  • Hamstring tendon
  • Bone-patellar tendon-bone
  • Biomechanics