title: Anatomic and morphological evaluation of the quadriceps tendon using 3-dimensional magnetic resonance imaging reconstruction: applications for anterior cruciate ligament autograft choice and procurement.
abstract: BACKGROUND
  The autograft of choice for anterior cruciate ligament (ACL) reconstruction remains controversial. The quadriceps tendon is the least utilized and least studied of the potential autograft options.
  
  
  OBJECTIVE
  To determine if the quadriceps tendon has the anatomic characteristics to produce a graft whose length and volume are adequate, reproducible, and predictable when compared with the other commonly used autografts.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Axial proton density magnetic resonance imaging (MRI) scans of 60 skeletally mature patients (30 male and 30 female) were evaluated. Volumetric analysis of 3-dimensional models of the patellar and quadriceps tendons was performed before and after the removal of a 10 mm-wide graft from both tendons. Length, thickness, and width measurements of the quadriceps tendon were made at predetermined locations. Anthropometric data were collected, and subgroup analysis, sex analysis, and linear regression were performed.
  
  
  RESULTS
  The mean percentage of volume remaining after removal of a 10 mm-wide graft from the patellar tendon was 56.6%, compared with 61.3% when harvesting an 80 mm-long graft of the same width from the quadriceps tendon. The intra-articular volume of the proposed quadriceps tendon graft was 87.5% greater than that of the patellar tendon graft. The mean length of the quadriceps tendon was 73.5 ± 12.3 mm in female patients and 81.1 ± 10.6 mm in male patients. These measurements were most highly correlated with patient height. The width of the quadriceps tendon decreased as one proceeded proximally from its insertion, and the thickness of the quadriceps tendon remained relatively constant.
  
  
  CONCLUSIONS
  The quadriceps tendon has the anatomic characteristics to produce a graft whose length and volume are both reproducible and predictable, while yielding a graft with a significantly greater intra-articular volume than a patellar tendon graft with a similar width.
authors.affiliation: John W. Xerogeanes, Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park Drive South, Suite 1000, Atlanta, GA 30329. jxeroge@emory.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Xerogeanes
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Mitchell
authors.forename: Peter A
authors.initials: PA
authors.lastname: Karasev
authors.forename: Ivan A
authors.initials: IA
authors.lastname: Kolesov
authors.forename: Spencer E
authors.initials: SE
authors.lastname: Romine
mesh_terms: D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D064592:Autografts; D003430:Cross-Sectional Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D052097:Quadriceps Muscle / Q000033:anatomy & histology*; D013710:Tendons / Q000033:anatomy & histology*; D014182:Transplantation, Autologous; D055815:Young Adult
keywords: anthropometric; autograft; correlation; patellar tendon (PT); quadriceps tendon (QT); volume