The Quad Link Technique for an All-Soft-Tissue Quadriceps Graft in Minimally Invasive, All-Inside Anterior Cruciate Ligament Reconstruction

The quadriceps tendon autograft has become an attractive option for anterior cruciate ligament reconstruction (ACLR) because of its robust size and versatility as a graft. Emerging literature has shown impressive biomechanical viability and promising clinical outcomes. The substantial size of a quadriceps graft and the shorter graft requirement of the all-inside approach obviate the need to harvest a bone plug for supplemental graft length and allow the use of an all-soft-tissue graft. The recent development of sophisticated harvest tools has mitigated prior issues reported with quadriceps tendon harvest. Quadriceps graft harvest is now less technically challenging, more reproducible, and can be done through a minimally invasive incision. However, an optimal technique for attachment of the adjustable loop suspensory fixation devices to an all-soft-tissue quadriceps tendon graft has yet to be established. We describe our method for quadriceps tendon harvest and present the Quad Link technique for attachment of adjustable loop suspensory fixation devices to a quadriceps graft for ACLR.