The Deep Myofascial Tissue Network and the Quadriceps Femoris Tendon Autograft: A Clinical Commentary

BACKGROUND: Quadriceps tendon (QT) autograft use for anterior cruciate ligament reconstruction (ACLR) has increased. Like other ACLR tendon autografts, this tissue is a component of the deep myofascial tissue network. CLINICAL QUESTION: How does QT autograft use for ACLR compare to hamstring tendon and bone-patellar tendon-bone autograft use from a deep myofascial tissue network perspective? KEY RESULTS: The QT is a histologically and morphologically less homogenous tissue than bone-patellar tendon-bone and hamstring tendon autografts. Harvest site damage to QT aponeurosis fusion points during surgical harvest may impair quadriceps femoris neuromuscular function and deep myofascial tissue network load sharing. CLINICAL APPLICATION: Physical therapists should be aware of inherent differences between ACLR tendon autografts. Studies are needed to better elucidate QT histological and morphological harvest defect tissue healing properties and how best to either preserve aponeurosis fusion points or minimize their damage. JOSPT Open 2026;4(3):254-263. Epub 25 March 2026. doi:10.2519/josptopen.2026.0184.