title: Quadriceps tendon autograft for anterior cruciate ligament reconstruction: a comprehensive review of current literature and systematic review of clinical results.
abstract: OBJECTIVE
  The autograft of choice for anterior cruciate ligament (ACL) reconstruction remains controversial. Recently, there has been an increase in interest in the quadriceps tendon as an autologous graft option for ACL reconstruction. The purposes of this study were to provide an in-depth review of quadriceps tendon anatomy, histology, and biomechanics and to synthesize reported clinical outcomes of ACL reconstructions using quadriceps tendon autografts. We hypothesize that (1) published studies on the anatomic, histologic, and biomechanical data regarding the quadriceps tendon support its use as a graft option for ACL reconstruction and (2) clinical outcomes of ACL reconstruction using quadriceps tendon autograft have similar clinical outcomes to bone-patellar tendon-bone autografts with less donor-site morbidity.
  
  
  METHODS
  We performed a comprehensive review of the literature regarding the anatomy, histology, and biomechanical studies of the quadriceps tendon, as well as a systematic review of clinical studies (Level of Evidence I-III) evaluating outcomes after ACL reconstruction using quadriceps tendon autograft. Stability outcomes, functional outcomes, range of motion, patient satisfaction, morbidity, and complications were comprised.
  
  
  RESULTS
  Fourteen studies were included in the review of clinical results, including 1,154 ACL reconstructions with quadriceps tendon autograft. Six studies directly compared quadriceps tendon autografts (n = 383) with bone-patellar tendon-bone autografts (n = 484). Stability outcomes (Lachman, pivot-shift, and instrumented laxity testing), functional outcomes (International Knee Documentation Committee and Lysholm scores), overall patient satisfaction, range of motion, and complications were similar between quadriceps tendon and other graft options. Less donor-site morbidity was seen in patients who underwent quadriceps tendon ACL reconstructions.
  
  
  CONCLUSIONS
  Use of the quadriceps tendon autograft for ACL reconstruction is supported by current orthopaedic literature. It is a safe, reproducible, and versatile graft that should be considered in future studies of ACL reconstruction.
  
  
  METHODS
  Level III, systematic review of Level I, II, and III studies.
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A.; Department of Orthopaedics, The Medical University of South Carolina, Charleston, SC, U.S.A.
authors.forename: Harris S
authors.initials: HS
authors.lastname: Slone
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A.
authors.forename: Spencer E
authors.initials: SE
authors.lastname: Romine
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A.
authors.forename: Ajay
authors.initials: A
authors.lastname: Premkumar
authors.affiliation: Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A.. Electronic address: jxeroge@emory.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: Xerogeanes
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D064592:Autografts; D001696:Biomechanical Phenomena; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D052097:Quadriceps Muscle / Q000033:anatomy & histology / Q000502:physiology / Q000637:transplantation; D013710:Tendons / Q000033:anatomy & histology / Q000502:physiology / Q000637:transplantation*; D014182:Transplantation, Autologous