Quadriceps augmentation of undersized hamstrings during ACL reconstruction

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Sports medicine

Background:

• Anterior cruciate ligament (ACL) reconstruction commonly uses hamstring autografts.
• Insufficient hamstring graft size is a clinical challenge, potentially necessitating allografts.
• Patient preference and specific surgical situations may favor autograft use.

Purpose of the Study:

• To evaluate the biomechanical properties of a composite hamstring-quadriceps autograft.
• To compare this composite graft against a standard hamstring autograft of equal size.
• To determine the viability of using quadriceps tendon to augment hamstring grafts for ACL reconstruction.

Main Methods:

• Harvesting semitendinosus, gracilis, and quadriceps tendons from cadaveric specimens.
• Preparing a standard hamstring autograft and a composite hamstring-quadriceps autograft of equal size.
• Biomechanical testing using a freeze-clamp mount to assess failure load, displacement, energy absorption, and stiffness.

Main Results:

• No statistically significant differences were observed between the composite and standard hamstring grafts.
• Peak failure load and displacement at failure were nearly identical for both graft types.
• All tested ACL graft constructs failed at the mid-substance.

Conclusions:

• A composite hamstring-quadriceps autograft demonstrates equivalent biomechanical properties to a standard hamstring autograft at time zero.
• Quadriceps tendon augmentation presents a potentially new and reliable method for addressing insufficient hamstring autografts in ACL reconstruction.