AANA Lab Course 913 - Advanced Knee Course-Pearls to Quadriceps Tendon Harvest

Video Transcription

Video Summary

The speaker discusses a technique for ACL reconstruction using a quadriceps tendon graft, developed since 1996 under John Fulkerson's encouragement. Initially, a bone plug was used but later discontinued except for posterior cruciate ligament (PCL) grafts, where it remains effective. MRI data shows the harvested quadriceps tendon increases in size one year post-op, indicating hypertrophy. Harvesting starts near the vastus medialis oblique (VMO), where the tendon is thickest, through a small incision. For a PCL graft, a bone plug is taken from the proximal patella. The graft is usually 6-8 mm thick and approximately 95 mm long. The speaker emphasizes sizing the graft properly to avoid overly tight grafts and prefers suspensory fixation on the femur with an endo button for even load distribution over interference screws. The quad tendon defect is closed after harvesting. The technique reduces complications such as patella fractures by harvesting medially. Overall, the method is reliable, economical, and backed by clinical experience.

Asset Caption

Walter Shelton, MD
Assist: Etan P. Sugarman, MD

Keywords

ACL reconstruction

quadriceps tendon graft

PCL graft

graft hypertrophy

suspensory fixation