Quadriceps Tendon Graft

This procedure consists of producing a strip of the end of the quadriceps tendon along with a block of bone off the top surface of the patella. This yields a tendon graft with bone on one end (similar to a patellar tendon graft) and soft tissue on the other.

The incision for harvesting a quad tendon graft is made above the kneecap and is often placed transversely (oriented horizontally across the knee as opposed to vertically). This is a smaller incision compared to the patellar tendon procedure, however, there is a separate small incision placed down over the tibia for the tibial tunnel.

Advantages

Quad tendon grafts have a thicker cross-sectional area than a corresponding patellar tendon graft with about the same tensile strength because the bone block comes from the upper pole of the patella tendon graft. Quad tendon grafts are a good alternative choice for revision ACL surgeries. Patients who have quad tendon grafts do not usually get patellar tendonitis symptoms upon returning to sports and often are able to kneel without much discomfort.

Disadvantages

The donor site risks and behaviors are similar to those of the patellar tendon graft. The quad tendon donor site does, to some extent, reconstitute after harvesting. Challenges of fixation are similar to the other graft choices.