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Quadriceps Tendon Graft Favored Over Patellar Tendon Graft for ACL Repair

When the anterior cruciate ligament is torn or ruptured a piece of tendon from around the knee is used as a replacement graft. Most often the hamstring tendon or patellar tendon is used. In this study a central piece of the quadriceps tendon is used instead. Strength of the muscle after the graft is measured and compared to the patellar tendon graft.

Testing was done on 10 cadavers (human knees preserved after death for study). Strength of the 10 knees was measured before removing tendon pieces for the study. A 10-mm wide tendon graft was taken from the middle of the patellar tendon. The same was done on the quadriceps tendon. Tests of strength were repeated for all 10 knees.

The authors report the following findings:
  • The quadriceps tendon was 90 percent stronger than the patellar tendon before
    taking a graft
  • The quadriceps tendon was 66 percent stronger than the patellar tendon after the graft
  • The strength of the quadriceps tendon after the graft was removed was one-third less.
  • The strength of the quadriceps tendon after graft was higher than the strength of the patellar tendon before the patellar graft was removed.

    The results of this study favor the quadriceps tendon graft over the patellar tendon for ACL repair. Another, larger study needs to be done before the quadriceps tendon is done routinely.


    Douglas J. Adams, PhD, et al. Residual Strength of the Quadriceps Versus Patellar Tendon After Harvesting a Central Free Tendon Graft. In The Journal of Arthroscopic and Related Research. January 2006. Vol. 22. No. 1. Pp. 76-79.

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