Folie 1 - Orthopaedic Summit 2014

Quad Tendon –
A Better Solution
Christian Fink, Christian Hoser
- Consultat/Product Royalties from Karl Storz
- Consultant for Synthes/DePuy/Mitek
ACL reconstruction is an evolution
Quadricepstendon - Anatomy
Staeubli H.U. Quantification of Intact Quadriceps Tendon, Quadriceps Tendon Insertion, and
Suprapatellar Fat Pat: MR Arthrography, Anatomy, and Cryosections in the Sagittal Plane. AJR 1999,
173: 691-698
Quadriceps - Anatomy
….The intra-articular volume of the proposed QT graft was 87.5% greater
than that of the patellar tendon graft.
Anatomic and Morphological Evaluation of the Quadriceps Tendon Using 3-Dimensional Magnetic Resonance
Imaging Reconstruction- Applications for Anterior Cruciate Ligament Autograft Choice and Procurement
John W. Xerogeanes, Phillip M. Mitchell, Peter A. Karasev,z PhD,
Ivan A. Kolesov,z PhD, and Spencer E. Romine,y MD
AJSM published on July 26, 2013
Biomechanical characteristics
Graft type
Ultimate tensile load(N)
Native ACL1
Doubled Semi/Gracilis2
B-Patellar Tendon-B(10mm) 3
Quadriceps (10mm) 4
1. Woo SL et al. Am J Sports Med 1991; 19
2. Hamner DL et al. J Bone Joint Surg [Am] 1999; 81-A
3. Cooper DE et al. Am J Sports Med 1993; 21
4. Stäubli HU et al. Am J Sports Med 1999; 27
Clinical studies
Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1882-8.
Outcomes for primary anterior cruciate reconstruction
with the quadriceps autograft: a systematic review.
Mulford JS, Hutchinson SE, Hang JR.
The quadriceps tendon autograft is a promising alternative
for primary ACL reconstructions with good outcomes and
minimal donor site morbidity.
Arthroscopy. 2014 May;30(5):593-8.
Is quadriceps tendon a better graft choice than
patellar tendon? a prospective randomized study.
Lund B, Nielsen T, Faunø P, Christiansen SE, Lind M.
The use of the QTB graft results in less kneeling pain,
graft site pain, and sensitivity loss than seen with BPTB
grafts; however, similar anterior knee stability and
subjective outcomes are seen. The results of this study
show that QTB is a viable option for ACL reconstruction.
Knee Surg Sports Traumatol Arthrosc. 2012 (Suppl 1)
Quadriceps tendon versus Hamstrings for ACL
reconstruction – a matched pair analysis
Höher J, et al.
- no significant difference in any clinical or subjective
- donor side morbidity – no difference
Knee Surg Sports Traumatol Arthrosc. 2014
Graft maturity of the reconstructed anterior cruciate
ligament 6 months postoperatively: a magnetic
resonance imaging evaluation of quadriceps tendon with
bone block and hamstring tendon autografts.
Ma Y, Murawski CD, Rahnemai-Azar AA, Maldjian C, Lynch AD, Fu FH.
The maturity of quadriceps tendon with bone block was better in
comparison with hamstring 6 months after anatomic SB ACL
reconstruction. This study is clinically relevant in that modifying the
individual rehabilitation according to the extent of graft maturity may be
necessary to optimize patient function and prevent re-injury of the ACL
Great(est!!!) graft – for ACL (PCL)
Reconstruction (primary and revision) 
harvest more difficult,
cosmetically less attractive
(compared to hamstrings)
New harvesting technique
Minimally Invasive Harvest of a Quadriceps Tendon Graft With or Without a Bone Block
Fink C, Herbort M, Abermann E, Hoser C
Arthroscopy Techniques, Published online: August 11, 2014
Scin incision (2.5 to 3 cm)
Karl Storz
Double knife (8-12mm)
Karl Storz
Tendon Separator (5mm)
Karl Storz
Tendon cutter (Lenght 6 cm - ACL, 8 cm - PCL)
QT without bone block
QT without bone block
New Concept of anatomy
c/o Robert Smigielski, Warschau
Flat midsubstance of the anterior cruciate ligament with tibial "C"shaped insertion site
Siebold R, Schuhmacher P, Fernandez F, Smigielski R, Fink C, Brehmer
A, Kirsch J. KSSTA 2014 May 20.
7mm (38.5mm2)
8x5mm (40mm2)
8mm (50.3mm2)
9x5mm (45mm2)
9mm (63.6mm2)
10x5mm (50mm2)
12x5mm (60mm2)
Single-Bundle Anterior Cruciate Ligament Reconstruction:
A Biomechanical Cadaveric Study of a Rectangular Quadriceps and Bone-Patellar
Tendon-Bone Graft Configuration Versus a Round Hamstring Graft.
- Improved rotational stability of rectangular vs round tunnels
Femural Tunnel
Tibial Tunnel
• QT reliable technique for ACL reconstruction
(primary and revision situations)
• QT – low harvest side morbidity and good
clinical results
• QT – bone block or soft tissue option
• AND…
….its the best graft because John
Fulkerson assured me that its the best
Thank you