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Estimating the adequacy of the free quadriceps tendon autograft length using anthropometric measures in anterior cruciate ligament reconstruction

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

This prospective study aimed to predict the adequacy of free quadriceps tendon (QT) autograft length using simple anthropometric measures.

Materials and methods

One hundred and eighty-four consecutive patients who underwent knee high-resolution MRI were enrolled in this study. The QT and native anterior cruciate ligament (ACL) length were measured using the oblique sagittal section. The adequate free QT length was calculated using the native ACL length and 30 mm for femoral and tibial tunnels in each patient. A QT shorter than the calculated length was considered inadequate. Age, sex, height, weight, body mass index, thigh circumference, and activity score were used to predict the adequacy of QT length with regression analysis.

Results

There were 92 men and 92 women with a mean age of 34.1 ± 8.0 years (range 18–45). The mean QT and ACL lengths were 69.0 ± 8.8 mm (range 48.1–90.3 mm) and 35.6 ± 2.5 mm (range 29.2–42.6 mm), respectively. The QT and the ACL lengths were longer in men (p < 0.001 for both). Twenty-three men and 39 women (total: 62, 33.7%) had inadequate QT length for a free QT autograft, and 6 patients (3 males, 3 females, 3.3%) had inadequate QT length with the bone block technique. There was a weak positive correlation between QT length and height (p < 0.001), weight (p < 0.001), and activity score (p = 0.007). Height was the only independent variable that predicted the QT length adequacy (r2 = 0.051, p = 0.009) but ROC analysis showed that height did not have an ability to detect a subject with an inadequate QT length (AUC: 0.384, 95% CI 0.300–0.468).

Conclusions

Free QT autografts may be inadequate in one-third of the patients, while a QT autograft with a bone block is almost always sufficient. Inadequate free QT autograft is more common in women. Although QT length correlated with height, it cannot be used as an accurate diagnostic tool to identify patients with an inadequate QT autograft. Preoperative measurement of the ACL and QT lengths by MRI might be beneficial to decide whether QT is usable, especially when harvesting without a bone block.

Level of evidence

Level II, diagnostic, prospective cohort study.

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

AUC:

Area under the curve

BMI:

Body mass index

BPTB:

Bone–patellar tendon–bone

CI:

Confidence interval

FOV:

Field of view

ICC:

Interclass correlation coefficient

MPR:

Multiplanar reconstruction

MRI:

Magnetic resonance imaging

ROC:

Receiver-operating characteristics

QT:

Quadriceps tendon

TE:

Echo time

TR:

Repetition time

VIF:

Variance inflation factor

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

No funds have been received for this study.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Alaaddin Keykubat University, Alanya, Turkey

    Yavuz Yuksel, Ebru Torun & Tarkan Ergun

  2. Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Varlık mah., Kazım Karabekir Cd., Muratpasa, Antalya, 07100, Turkey

    Ozkan Kose

  3. Department of Biometry and Statistics, Faculty of Agriculture, Akdeniz University, Antalya, Turkey

    Fatma Yardibi

  4. Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey

    Levent Sarikcioglu

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  1. Yavuz Yuksel
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Contributions

Study conception and design: OK, YY, and TE; acquisition of data: FY, TE, ET, and YY; analysis and interpretation of data: LS, YY, FY, and OK; drafting of the manuscript: YY, TE, OK, LS, and FY; critical revision: OK, YY, TE, LS, and FY (initials of authors’ names).

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Correspondence to Ozkan Kose.

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Institutional Review Board approved the study protocol (Date/Issue: 09.12.2020/26-5).

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Written informed consent was provided by the participants.

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Yuksel, Y., Kose, O., Torun, E. et al. Estimating the adequacy of the free quadriceps tendon autograft length using anthropometric measures in anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 142, 2001–2010 (2022). https://doi.org/10.1007/s00402-021-04197-0

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  • DOI: https://doi.org/10.1007/s00402-021-04197-0

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