Skip to main content

Advertisement

SpringerLink
Log in

Revision anterior cruciate ligament reconstruction using the ipsilateral Quadriceps tendon autograft: a modular reconstructive option

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Failed ACL reconstruction is a common occurrence nowadays due to the increased incidence of ACL surgeries and return to full activities following the surgery. Several challenges might stand in the face of this revision surgery particularly the graft harvest and its suitability to the situation with possible widening of the tunnel and the avoidance of additional morbidity at the contralateral side or anterior knee pain as in patellar tendon harvest. The aim of this study is to evaluate the ipsilateral quadriceps tendon as a source of autograft in revision ACL surgery which constitutes a viable option that can potentially decrease the morbidity of the procedure, and meanwhile provide a graft substitute that can be tailored to suit the dilated tunnels commonly encountered in revision surgery, thus giving the patients a good potential for better functional outcome.

Methods

Revision anterior cruciate ligament reconstruction was done in 30 patients using the ipsilateral quad tendon as a pure soft tissue or with a bony fragment.

Results

The mean subjective international Knee Documentation Committee score (IKDC score) at two years follow-up was 65.83 ± 7.20. There is statistically significant improvement of the objective as well as the subjective IKDC scores at the end of follow-up when compared to the preoperative as well as the 6-month evaluation figures. The KT1000 arthrometer recorded a mean of 4.50 ± 1.07. Significant improvement of the limb symmetry index was at two years duration.

Conclusions

The quadriceps tendon can be a solution for several challenges that might appear during the revision ACL surgery with comparable results to other tendons and with minimal morbidity on the function of the harvested muscle tendon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Data availability

Patients’ data are available on request.

Code availability

Not applicable.

References

  1. Vališ P, Sklenský J, Repko M, Rouchal M, Novák J, Otaševič T (2014) Most frequent causes of autologous graft failure in anterior cruciate ligament replacement. Acta Chir Orthop Traumatol Cech 81:371–379

    Article  PubMed  Google Scholar 

  2. Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR (2013) Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med 41:1808–1812. https://doi.org/10.1177/0363546513493896

    Article  PubMed  Google Scholar 

  3. Legnani C, Zini S, Borgo E, Ventura A (2017) Revision anterior cruciate ligament reconstruction with contralateral hamstring tendon grafts: 6 years follow-up. Joints 5:17–20. https://doi.org/10.1055/s-0037-1601410

    Article  PubMed  PubMed Central  Google Scholar 

  4. Ferretti A, Monaco E, Caperna L, Palma T, Conteduca F (2013) Revision ACL reconstruction using contralateral hamstrings. Knee Surg Sports Traumatol Arthrosc. 21(3):690–5. https://doi.org/10.1007/s00167-012-2039-x

  5. Xerogeanes JW (2019) Quadriceps tendon graft for anterior cruciate ligament reconstruction: the graft of the future! Arthrosc : J Arthrosc Relat Surg : Off Publ Arthrosc Assoc N Ame Int Arthrosc Assoc 35:696–697. https://doi.org/10.1016/j.arthro.2019.01.011

    Article  Google Scholar 

  6. Todor A, Caterev S, Nistor DV, Khallouki Y (2016) Free bone plug quadriceps tendon harvest and suspensory button attachment for anterior cruciate ligament reconstruction. Arthrosc Tech 5:e541-544. https://doi.org/10.1016/j.eats.2016.02.001

    Article  PubMed  PubMed Central  Google Scholar 

  7. Krebs N, Yaish A, O’Neill N (2019) Anatomic Evaluation of the quadriceps tendon in cadaveric specimens: application for anterior cruciate ligament reconstruction graft choice. Spartan Med Res J 4:7961. https://doi.org/10.51894/001c.7961

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ugwuoke A, Syed F, El-Kawy S (2020) Predicting adequacy of free quadriceps tendon autograft, for primary and revision ACL reconstruction, from patients’ physical parameters. Knee Surg Sports Traumatol Arthrosc 28:448–453. https://doi.org/10.1007/s00167-019-05640-x

    Article  PubMed  Google Scholar 

  9. Höher J, Möller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6:231–240. https://doi.org/10.1007/s001670050105

    Article  PubMed  Google Scholar 

  10. Osti L, Buda M, Osti R, Massari L, Maffulli N (2017) Preoperative planning for ACL revision surgery. Sports Med Arthrosc Rev 25:19–29. https://doi.org/10.1097/jsa.0000000000000140

    Article  PubMed  Google Scholar 

  11. Di Benedetto P, Di Benedetto E, Fiocchi A, Beltrame A, Causero A (2016) Causes of failure of anterior cruciate ligament reconstruction and revision surgical strategies. Knee Surg Relat Res 28:319–324. https://doi.org/10.5792/ksrr.16.007

    Article  PubMed  PubMed Central  Google Scholar 

  12. Imhoff FB, Comer B, Obopilwe E, Beitzel K, Arciero RA, Mehl JT (2021) Effect of slope and varus correction high tibial osteotomy in the ACL-deficient and ACL-reconstructed knee on kinematics and ACL graft force: a biomechanical analysis. Am J Sports Med 49:410–416. https://doi.org/10.1177/0363546520976147

    Article  PubMed  Google Scholar 

  13. Morgan JA, Dahm D, Levy B, Stuart MJ (2012) Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg 25:361–368. https://doi.org/10.1055/s-0031-1299662

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32:543–549. https://doi.org/10.1177/0363546504263151

    Article  PubMed  Google Scholar 

  15. Samitier G, Marcano AI, Alentorn-Geli E, Cugat R, Farmer KW, Moser MW (2015) Failure of anterior cruciate ligament reconstruction. Arch Bone Joint Surg 3:220–240

    PubMed  PubMed Central  Google Scholar 

  16. Condello V, Zdanowicz U, Di Matteo B, Spalding T, Gelber PE, Adravanti P, Heuberer P, Dimmen S, Sonnery-Cottet B, Hulet C, Bonomo M, Kon E (2019) Allograft tendons are a safe and effective option for revision ACL reconstruction: a clinical review. Knee Surg Sports Traumatol Arthrosc 27:1771–1781. https://doi.org/10.1007/s00167-018-5147-4

    Article  CAS  PubMed  Google Scholar 

  17. Salmon LJ, Pinczewski LA, Russell VJ, Refshauge K (2006) Revision anterior cruciate ligament reconstruction with hamstring tendon autograft: 5- to 9-year follow-up. Am J Sports Med 34:1604–1614. https://doi.org/10.1177/0363546506288015

    Article  PubMed  Google Scholar 

  18. Tomihara T, Hashimoto Y, Taniuchi M, Takigami J, Han C, Shimada N (2017) One-stage revision ACL reconstruction after primary ACL double bundle reconstruction: is bone-patella tendon-bone autograft reliable? Knee Surg Sports Traumatol Arthrosc 25:1653–1661. https://doi.org/10.1007/s00167-017-4483-0

    Article  PubMed  Google Scholar 

  19. Xie X, Xiao Z, Li Q, Zhu B, Chen J, Chen H, Yang F, Chen Y, Lai Q, Liu X (2015) Increased incidence of osteoarthritis of knee joint after ACL reconstruction with bone-patellar tendon-bone autografts than hamstring autografts: a meta-analysis of 1,443 patients at a minimum of 5 years. Eur J Orthop Surg Traumatol : Orthopedie Traumatol 25:149–159. https://doi.org/10.1007/s00590-014-1459-3

    Article  Google Scholar 

  20. Bottoni CR, Smith EL, Shaha J, Shaha SS, Raybin SG, Tokish JM, Rowles DJ (2015) Autograft versus allograft anterior cruciate ligament reconstruction: a prospective, randomized clinical study with a minimum 10-year follow-up. Am J Sports Med 43:2501–2509. https://doi.org/10.1177/0363546515596406

    Article  PubMed  Google Scholar 

  21. Matassi F, Giabbani N, Arnaldi E, Tripodo A, Bonaspetti G, Bait C, Ronga M, Di Benedetto P, Zaffagnini S, Jannelli E, Schiavone Panni A, Berruto M (2022) Controversies in ACL revision surgery: Italian expert group consensus and state of the art. J Orthop Traumatol 23:32. https://doi.org/10.1186/s10195-022-00652-9

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kanakamedala AC, de Sa D, Obioha OA, Arakgi ME, Schmidt PB, Lesniak BP, Musahl V (2019) No difference between full thickness and partial thickness quadriceps tendon autografts in anterior cruciate ligament reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 27:105–116. https://doi.org/10.1007/s00167-018-5042-z

    Article  PubMed  Google Scholar 

  23. Buescu CT, Onutu AH, Lucaciu DO, Todor A (2017) Pain level after ACL reconstruction: a comparative study between free quadriceps tendon and hamstring tendons autografts. Acta Orthop Traumatol Turc 51:100–103. https://doi.org/10.1016/j.aott.2017.02.011

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Alexandria University, Alexandria, Egypt

    Mohamed Abouheif

  2. Department of Orthopedics and Traumatology, Mansoura University, Al-Gomhoria Street 35516, Mansoura, Egypt

    Mohamed M. F. Sharaby

Authors
  1. Mohamed Abouheif
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed M. F. Sharaby
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Mohamed Abouheif:

• Formulate research hypothesis.

• Construction of proposal.

• Submitting research approval.

• Data collection.

• Statistical analysis

• Literature review and drafting manuscript.

Mohamed MF Sharaby:

• Formulate research hypothesis.

• Calculation of sample size.

• Statistical analysis

• Data collection.

• Literature review and drafting manuscript.

• Submission of paper.

Corresponding author

Correspondence to Mohamed Abouheif.

Ethics declarations

Ethical approval

This study was started after ethical committee approval from Alexandria University, Egypt, with the number 1414/13–6-2020.

Consent to participate

All cases included in this study signed a formal consent to participate in the study.

Consent to publish

All patients/authors participating in the study were informed regarding the possible publication of the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Level of evidence.

Level II clinical trial.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abouheif, M., Sharaby, M.M.F. Revision anterior cruciate ligament reconstruction using the ipsilateral Quadriceps tendon autograft: a modular reconstructive option. International Orthopaedics (SICOT) 47, 2967–2976 (2023). https://doi.org/10.1007/s00264-023-05878-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05878-8

Keywords

Search

Navigation