Knee | ACL Reconstruction
ACL reconstruction surgery is one of the most commonly performed procedures for individuals with ACL tears, knee instability, and injuries related to sports or other activities. As an orthopedic surgeon specializing in sports medicine and knee conditions, Dr. Aaron Schwartz offers individualized ACL reconstruction treatment in Portland, Oregon, including reconstruction using a quadriceps tendon (quad tendon) autograft.
ACL Reconstruction Overview
The ACL (anterior cruciate ligament) is one of the major ligaments responsible for stabilizing the knee. ACL tears are common in athletes and active individuals and frequently occur during sports that involve cutting, pivoting, jumping, or sudden changes in direction. They can also occur following traumatic injuries.
Unlike some other ligaments, a completely torn ACL has limited ability to heal on its own. When an ACL tear causes persistent instability or prevents a patient from safely returning to desired activities, ACL reconstruction surgery may be recommended.
During ACL reconstruction, the torn ACL is replaced with a new ligament made from a tendon graft. The graft is secured within the knee using minimally invasive arthroscopic techniques and gradually incorporates as new ligament tissue develops.
Minimally Invasive Arthroscopic ACL Reconstruction
Advancements in orthopedic surgery have made it possible to perform ACL reconstruction through minimally invasive arthroscopic techniques. Arthroscopy uses a small camera and specialized instruments inserted through small incisions around the knee.
This approach allows the surgeon to evaluate and treat the ACL injury while minimizing disruption to surrounding tissues. ACL reconstruction may also address associated injuries, including meniscus tears, cartilage injuries, or other ligament damage, when appropriate.
Recovery following ACL reconstruction involves a structured rehabilitation program focused on restoring knee motion, strength, stability, and function.
Quad Tendon ACL Reconstruction
Dr. Schwartz trained with the pioneer of modern Quad tendon ACL reconstruction and has been using it as his primary graft option since he finished fellowship in 2017. A quad tendon graft uses a portion of the patient’s own quadriceps tendon, located above the kneecap, to create a new ACL.
The quadriceps tendon is a thick and strong tendon that can provide a large-diameter graft for ACL reconstruction. Quad tendon ACL reconstruction has become an increasingly popular option for athletes and active patients and may be used for both primary ACL reconstruction and selected revision ACL surgeries.
Why Choose a Quad Tendon ACL Graft?
There are several graft options for ACL reconstruction, including the quadriceps tendon, patellar tendon, hamstring tendons, cadaver tendon, the BEAR procedure and ACL repair. There is not one graft that is best for every patient. The appropriate graft depends on factors such as age, activity level, sport, anatomy, previous surgery, and individual goals. Dr. Schwartz can help guide patients to which graft is the best choice for them.
Potential advantages of a quad tendon ACL graft include:
- Large, strong graft: The quadriceps tendon provides substantial tissue that can be shaped to the patient’s anatomy.
- Potentially less anterior knee pain: Compared with patellar tendon grafts, quadriceps tendon harvest may result in less pain at the front of the knee and less discomfort with kneeling.
- Preservation of the hamstrings: A quad tendon graft leaves the hamstring tendons available, which may be advantageous for athletes who rely heavily on hamstring strength.
- Versatility: Quad tendon autografts can be used for primary ACL reconstruction and many revision ACL procedures.
- Autograft tissue: The graft comes from the patient’s own body rather than from a donor.
For additional insight into ACL reconstruction, Dr. Schwartz recommends watching this video, shared courtesy of medical device company Arthrex.
Frequently Asked Questions
A quad tendon ACL graft is a portion of the patient’s own quadriceps tendon that is harvested and used to reconstruct a torn ACL. The quadriceps tendon is a large, strong tendon that provides an excellent source of tissue for ACL reconstruction.
Quadriceps tendon grafts provide a large and strong graft for ACL reconstruction. Research has demonstrated good outcomes with quadriceps tendon autografts, with clinical results that are generally comparable to other commonly used ACL autografts.
The decision between a quad tendon, patellar tendon, or hamstring graft is individualized rather than based solely on graft strength.
Both grafts are well-established options for ACL reconstruction. One potential advantage of the quadriceps tendon is less morbidity at the front of the knee. Patients undergoing quad tendon harvest may experience less anterior knee pain and less discomfort with kneeling compared with patients who have a patellar tendon graft.
This can be an important consideration for athletes and active individuals whose activities involve frequent kneeling or pressure on the front of the knee.
Both are effective ACL reconstruction options. A quad tendon graft provides a large graft while avoiding removal of the hamstring tendons.
Preserving the hamstrings may be particularly relevant for athletes participating in sports that place significant demands on hamstring strength. The best ACL graft, however, depends on the individual patient’s anatomy, sport, goals, and surgical history.
A portion of the quadriceps tendon is harvested while preserving the majority of the tendon. Healing occurs at the harvest site over time.
Quadriceps weakness is common following ACL reconstruction regardless of graft choice, which is why restoring quadriceps strength is a major focus of rehabilitation.
The harvested portion of the quadriceps tendon heals and remodels following surgery. Rehabilitation progressively restores quadriceps strength and function.
One potential benefit of a quadriceps tendon graft is less anterior knee pain compared with patellar tendon grafts. It may also result in less discomfort with kneeling.
However, every ACL reconstruction is different, and postoperative pain varies between patients.
Recovery varies depending on the patient, the extent of the ACL injury, associated procedures, and progress during rehabilitation.
Early rehabilitation focuses on reducing swelling, restoring knee motion, and regaining quadriceps activation. Strengthening, running, jumping, and sport-specific activities are gradually introduced as the knee recovers.
For athletes returning to sports involving cutting and pivoting, return to sport should be based on objective strength, functional, movement, and psychological readiness rather than simply reaching a specific number of months after surgery.
Return to sports is individualized. Before returning to unrestricted pivoting and cutting activities, patients should demonstrate appropriate knee stability, strength, hop performance, movement quality, and readiness for their specific sport.
Returning to sports too quickly can increase the risk of reinjury, including another ACL tear.
Yes. A quadriceps tendon autograft can be an excellent option for selected revision ACL reconstructions, particularly when other common graft sources have already been used.
Revision ACL surgery is more complex than primary reconstruction and requires careful evaluation of previous surgery, bone tunnels, knee alignment, meniscus and cartilage status, and available graft tissue.
Each ACL graft has advantages and disadvantages.
- Patellar tendon graft: A well-established ACL graft with excellent long-term outcomes, but some patients experience anterior knee pain or discomfort with kneeling.
- Hamstring graft: Avoids harvesting the patellar tendon but uses the hamstring tendons as the graft source.
- Quadriceps tendon graft: Provides a large, strong graft while preserving the hamstring tendons and may have less anterior knee morbidity than a patellar tendon graft.
The best graft depends on the patient’s individual anatomy, activity level, sport, goals, and surgical history.
Many patients undergoing ACL reconstruction may be candidates for a quadriceps tendon autograft. It may be particularly useful for athletes, active patients, individuals who want to preserve their hamstring tendons, patients concerned about kneeling pain, and some patients undergoing revision ACL reconstruction.
During an evaluation, Dr. Schwartz can discuss the different ACL graft options and determine which approach is most appropriate for the patient’s injury, activity level, and goals.
ACL Reconstruction in Portland
If you have an ACL tear or ongoing knee instability and are considering ACL reconstruction, an orthopedic sports medicine evaluation can help determine whether surgery is appropriate and which reconstruction technique and graft option best fit your goals.
Dr. Aaron Schwartz treats ACL injuries in athletes and active individuals and offers individualized surgical treatment, including quad tendon ACL reconstruction when appropriate.