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Preoperative MRI-Based Assessment of the Quadriceps Tendon Autograft and Its Implications for Patient-Personalized
Lorenz Pichler1,2, Felix -Euler-Rolle1, Jakob Mayerl1
1Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria.
Background:
Personalized strategies are increasingly applied in orthopedic surgery, yet anatomical personalization in sports medicine remains limited. The quadriceps tendon (QT), increasingly used as an autograft for ACL reconstruction, shows potential patient- and gender-specific (P-G) anatomical variability. This study evaluated whether standard knee MRI allows assessment of the full QT anatomy, its reproducibility, and potential P-G differences.
Materials And Methods:
In this retrospective study, 200 patients (100 female, 100 male) undergoing knee MRI at 36 different radiological institutes were included. QT anatomy was analyzed using standardized MRI-based measurement protocols by two blinded observers. Inter-rater reliability was assessed, and parameters of QT anatomy were tested for correlations with body height (BH) and body weight (BW) as well as for sex-specific differences.
Results:
Measurements of QT anatomy showed good reproducibility (ICC = 0.78, p < 0.001). The full length of the QT could not be measured in any case. However, a length of at least 6 cm-corresponding to the minimal length required for a QT autograft in ACL reconstruction-was measurable in 30 cases (15%). The laminar organization deviated from the traditionally described three-layered structure in 38% of cases and differed significantly between sexes (p = 0.027). A weak correlation was observed between laminar organization and BH, and no correlation with BW.
Conclusion:
Standard knee MRI allows reliable assessment of most QT anatomical features but fails to capture its full length. Significant sex-specific differences and anatomical variability should be considered in QT autograft planning.
