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@physicaltherapyresearch
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1,365 Likes73 Comments

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ACLR, Which Graft is Best?
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INTRODUCTION
Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic surgeries in the world for active individuals.
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The type of graft used is an important decision for ACL reconstructions.
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Despite extensive research on the best graft choice, discrepancy still exists among, hamstring, patellar tendon and quad tendon grafts.
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Xerogeanes (2019), makes an argument the quad tendon is the best graft choice.
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Recently, Quad tendon grafts have has gained popularity.
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The β€˜all soft tissue’ quadriceps graft offers many advantages over other autograft choices. .
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There are 20% more collagen fibrils per cross-sectional area than the patellar tendon (PT). .
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Biomechanically, its ultimate load is 70% > than similar width PT grafts.
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Also, it’s modulus is more similar to the native ACL than either PT or hamstring grafts.
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Anatomically the quadriceps tendon has significantly more volume than the PT. .
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Following harvest, the quadriceps tendon is still 80% stronger than the intact PT.
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The length and cross-sectional area of the quadriceps tendon graft can be tailored to the needs of the patient. .
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On any patient over 5 feet tall, a graft length of 7Β cm can be obtained. .
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Commonly Quad graft thickness is almost 2x thicker than the same patients PT, making it easy to harvest a graft diameter from 7 to 11Β mm.
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Thus, this graft can be customized for both primary and revision surgeries.
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Harvest site morbidity is minimal. .
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An incision less than 2Β cm in an area with no significant cutaneous nerves without harvest of any patella bone leads to no significant harvest site pain, numbness, or palpable defect.
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Clinical outcomes using this graft are excellent. .
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The prospective data on nearly 1,000 quad grafts, with a mean patient age being 20Β years old, show a 4.2% failure rate. .
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IMPLICATIONS:
Xerogeanes (2019), argues soft tissue quadriceps graft will be the surgical choice for ACL reconstruction for future athletes.
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THOUGHTS? REACTIONS? ARGUMENTS?
Let us know! Comment Below!
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SOURCE:
Xerogeanes, J., 2019. Quadriceps Tendon Graft for Anterior Cruciate Ligament Reconstruction

28 Jul 2019

Comments
  • @imovephysiotherapy

    Good food for thought πŸ’­ πŸ”₯

    11 Oct 2019

  • @ph1l1ppgrie

    I had my #aclreconstruction by quadriceps graft + fibertape 18 days ago. Already on the bike and squating lightweights 😊 No comparison to my hamstring graft on my other leg a couple of years ago... Key is to skip crutches and be active as early as possible...

    03 Sep 2019

  • @thelionheartcommunity

    this is so interesting !

    02 Sep 2019

  • @ryancartiers

    Is anyone growing ligaments with stemcells?

    31 Jul 2019

  • @alexzelesnikar

    With all this being said is there been any information released of post op patients from the durability and/ or likeliness to re-tear the newly constructed tendon from each of the different of the three grafts?

    29 Jul 2019

  • @shelleya12

    @kateanderson13

    29 Jul 2019

  • @mina2_2

    Got a PT back in 2014. I remember the MD telling me PTs would be the longest recovery but strongest option. Wish I knew about the QT!

    29 Jul 2019

  • @whiskeytherapy

    Nice read, thanks πŸ₯ƒπŸ‘ŠπŸ™πŸΌ

    29 Jul 2019

  • @kamran_at_hari

    I believe a good protocol for rehabilitation before and after surgery is more important.

    29 Jul 2019

  • @waxingcrescent83

    I believe that pre-op education and rehab is essential and that a good strengthening program for the leg post op is best to prevent re-injury.

    29 Jul 2019

  • @lydianeo2

    @dreneo_

    29 Jul 2019

  • @evandromartirano

    @tommasobaldaccini

    29 Jul 2019

  • @paulskousen

    Whatever the surgeon is most comfortable with!

    29 Jul 2019

  • @reese660

    @7mandi1417 @rinitamascarenhas @anniebumble98 @fariha1610

    29 Jul 2019

  • @daniel_nisbet

    Did my inservice over this, still need a bit more research on it but agreed it is becoming more popular and may be the best option within the next 5 years

    29 Jul 2019

  • @dr.hiroperera

    This is really interesting! I saw my first ACLR and quad tendon graft and was curious on what the literature says. Thank you for the post!

    29 Jul 2019

  • @kailynbalfour

    I prefer the quadriceps graft over the hamstring from my own personal experience. The rehab process was a lot easier on my body and I was able to return back to university soccer a lot better. My hamstring graft re-tore 11 months after my first surgery.

    29 Jul 2019

  • @officialimikev

    I've had hamstring and quad. I'm 11 months out of my quad and I feel great, but I also did with my hamstring until I experienced multiple sprains at 12 months until retearing. Placement of graft was an issue and enlarging or drill holes.

    29 Jul 2019

  • @luisborn

    None πŸ€—

    29 Jul 2019

  • @tuxedophysiotherapy

    interesting. Thanks for sharing and summarizing so beautifulluy. I do note the study was done on 20ish year old athletes, so my thoughts are in agreement with some of the other comments...this may be the best graft for this particular population.

    29 Jul 2019

  • @_gillie5

    Depends on the patient’s needs, chosen sport and age potentially

    29 Jul 2019

  • @rucha898

    Hamstring tendon graft

    29 Jul 2019