Mini-Invasive Harvesting of Quadriceps Tendon Graft With Patellar Bone Block for ACL Reconstruction Using a Dedicated...

The selection of the type of graft used to reconstruct the anterior cruciate ligament (ACL) remains a matter of debate. In the past, the quadriceps tendon (QT) was associated with considerable morbidity and less favorable outcomes than other grafts. Improvements in harvesting methods have decreased morbidity of the surgical procedure and led to an increase in the use of QT in recent years.

The QT graft with patellar bone block is a viable option for all patients with closed physis undergoing ACL reconstruction. It is especially suitable for young and active patients who practice activities that require kneeling or athletes in which hamstrings preservation is advisable.

A vertical mini-invasive longitudinal incision starts 1 cm proximal to the middle of the patellar pole. After dissection, the bone block is marked and detached with an oscillating saw. A drill hole is performed in the bone block to serve for the passage of a traction suture. The bone block is lifted with the help of the traction suture, and the graft is trimmed to the desired diameter. The layer between tendon and capsule is separated by blunt dissection to spare the capsule of the suprapatellar pouch. Harvesting is achieved using a dedicated QT harvester. Usually, a graft length of 8 cm is harvested. The defect in the QT is closed using a suture passer at the proximal end. Finally, the graft is prepared and calibrated according to the planned technique for ACL reconstruction.

There was no major intraoperative complication in the senior author's series (more than 50 patients) using the dedicated QT harvester. On rare occasions (<10% of the cases), the device opened the suprapatellar joint capsule, creating the additional need for capsular repair during defect closure. On two occasions, the graft was shorter than expected, which may have been caused by insufficient dissection or improper use of the harvester.

ACL reconstruction with minimally invasive QT graft harvesting methods has shown very good clinical outcomes with few complications. It can be recommended for primary and revision ACL reconstruction.

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