Anatomic Evaluation of the Quadriceps Tendon in Cadaveric Specimens: Application for Anterior Cruciate Ligament Reconstruction Graft Choice

PURPOSE: The quadriceps tendon (QT) is an autograft option for primary and revision anterior cruciate ligament (ACL) reconstruction. Techniques for predicting the appropriate graft size are limited. The purpose of this study was to evaluate the morphologic features of the QT in cadaveric specimens and compare the findings to recent MRI studies. MATERIALS AND METHODS: Macroscopic dissections were performed on 10 cadaveric knees. Using the distal myotendinous junction of the rectus femoris and superior pole of the patella as anatomic landmarks, the QT was isolated. Tendon length, width, and thickness were recorded at 10 millimeter (mm) increments. A central 80 mm x 10 mm graft was harvested, after which the graft was measured in an identical fashion. Specimen anthropometric data was collected. Subgroup analysis and linear regression were then performed using Microsoft Excel 2011 Office Analysis ToolPak. RESULTS: The mean QT length was 83.3 +/- 14.4 mm, ranging from 63 to 108 mm. The mean percentage of remaining QT volume following graft harvesting was 63.3%. QT length showed significant correlation with patient height (correlation coefficient: 0.719, p = 0.027). QT thickness remained relatively constant, while the width is greatest at its patellar insertion and gradually decreases proximally towards the myotendinous junction. CONCLUSION: The QT has the anatomical features to produce a robust autograft for ACL reconstruction. During preoperative evaluation of graft size and quality, patient height should be considered as it is strongly correlated with the length of the potential graft. Our findings support the use of MRI as a way to preoperatively assess the QT as an autograft when performing an ACL reconstruction.