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Related Experiment Video

Updated: Feb 1, 2026

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Quadriceps augmentation of undersized hamstrings during ACL reconstruction.

W Kyle Wilson1, Randal Morris1, Andrew Coskey1

  • 1The University of Texas Medical Branch, Department of Orthopaedic Surgery and Rehabilitation, 301 University Blvd., Rt. 0165, Galveston, TX 77555-0165, United States of America.

The Knee
|December 18, 2018
PubMed
Summary

Augmenting hamstring autografts with quadriceps tendons for anterior cruciate ligament (ACL) reconstruction shows no biomechanical difference compared to standard hamstring grafts. This technique offers a reliable alternative when hamstring grafts are insufficient.

Keywords:
ACL autograftACL graftACL reconstructionQuadriceps tendon

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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.