Dadoo Sahil, Keeling Laura E, Runer Armin, Musahl Volker
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Video J Sports Med. 2023 Sep 11;3(5):26350254231156238. doi: 10.1177/26350254231156238. eCollection 2023 Sep-Oct.
Quadriceps tendon (QT) autograft represents an excellent option for anterior cruciate ligament (ACL) reconstruction (ACLR), with minimal donor site morbidity and failure rates comparable with bone-patellar tendon-bone (BPTB) autograft. This video aims to provide technical tips for ACLR using all-soft-tissue QT autograft.
ACLR with QT autograft is indicated in young, active ACL-injured patients who desire a return to sport. It represents a viable option in both primary and revision ACLR, as well as in skeletally immature patients. It is particularly indicated in those who kneel frequently, such as wrestlers or laborers, due to the lower incidence of postoperative anterior knee pain.
A vertical incision is used to harvest a 10 mm × 70 mm partial thickness, all-soft-tissue QT graft. Care is taken not to violate the capsule or musculature. If necessary, graft size is modified based on preoperative magnetic resonance imaging (MRI) measurement of the notch width. The graft is then prepared with continuous loop suspensory fixation on the femoral side and draw sutures on the tibial side. The lateral femoral notch is debrided to allow for visualization of the posterior wall to enable anatomic tunnel placement. When possible, the tibial stump is preserved. The femoral tunnel is drilled via an anteromedial portal and the tibial tunnel via a tibial guide. The graft is then passed through the tibial stump into the femur. It is fixed on the tibial side with a PEEK interference screw in full extension with application of a posterior drawer.
Outcomes following ACLR with QT autograft are excellent, with laxity and patient-reported outcomes comparable with those following ACLR with BPTB and hamstring autograft. Furthermore, QT ACLR has been shown to result in less donor site morbidity than BPTB autograft, and lower rates of failure and infection compared with hamstring autograft.
ACLR with QT autograft is a good option in young, active patients in both the primary and revision settings. Advantages of QT ACLR include less donor site morbidity than BPTB, and lower rates of failure compared with hamstring autograft in young patients.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
股四头肌肌腱（QT）自体移植物是前交叉韧带（ACL）重建（ACLR）的极佳选择，供区并发症极少，失败率与髌腱-骨（BPTB）自体移植物相当。本视频旨在提供使用全软组织QT自体移植物进行ACLR的技术要点。
对于希望恢复运动的年轻、活跃的ACL损伤患者，可采用QT自体移植物进行ACLR。它在初次和翻修ACLR以及骨骼未成熟患者中都是可行的选择。对于经常跪地的人群，如摔跤运动员或体力劳动者，由于术后前膝疼痛发生率较低，尤其适用。
采用垂直切口获取一条10毫米×70毫米的部分厚度全软组织QT移植物。注意不要损伤关节囊或肌肉组织。如有必要，根据术前磁共振成像（MRI）测量的髁间窝宽度调整移植物大小。然后在股骨侧采用连续袢悬吊固定法、在胫骨侧采用牵引缝线制备移植物。清理股骨外侧髁间窝，以便观察后壁，从而进行解剖隧道定位。尽可能保留胫骨残端。通过前内侧入路钻股骨隧道，通过胫骨导向器钻胫骨隧道。然后将移植物穿过胫骨残端进入股骨。在完全伸直位应用后抽屉试验的情况下，用聚醚醚酮（PEEK）挤压螺钉在胫骨侧固定移植物。
采用QT自体移植物进行ACLR的效果极佳，松弛度和患者报告的结果与采用BPTB和腘绳肌自体移植物进行ACLR的结果相当。此外，与BPTB自体移植物相比，QT ACLR的供区并发症更少，与腘绳肌自体移植物相比，失败率和感染率更低。
对于年轻、活跃的患者，无论是初次还是翻修手术，采用QT自体移植物进行ACLR都是一个不错的选择。QT ACLR的优点包括与BPTB相比供区并发症更少，与年轻患者的腘绳肌自体移植物相比失败率更低。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本稿件提交了患者的豁免声明或其他书面批准形式以供发表。
