Handheld Ultrasound for Personalized All-Soft-Tissue Quadriceps Tendon Anterior Cruciate Ligament Reconstruction

Background: The use of quadriceps tendon autograft for anterior cruciate ligament (ACL) reconstruction (ACLR) has substantially increased in popularity. Advantages include similar clinical outcomes to other autografts and greater intra-articular tendon volume. However, injury to the quadriceps muscle during graft harvest may compromise quadriceps recovery, which reduces clinical outcomes. Females have been identified as being at higher risk of poor quadriceps recovery after all soft tissue quadriceps tendon ACLR, with 61% of females reported to be unable to achieve terminal extension 6 weeks after surgery. Indications: To allow for 15 to 20 mm of graft-to-bone tunnel healing, autografts 65 to 70 mm long and 10 mm wide have been recommended for adults. A 3-dimensional magnetic resonance imaging study showed that quadriceps tendon length correlates with height and that 90% of patients 5’6” or taller had a quadriceps tendon length >70 mm. However, the Centers for Disease Control and Prevention (CDC) data show that 80% of adult females and 18% of adult males are shorter than 5’6” tall. This means that, for about half of adults and the vast majority of females, the quadriceps tendon may not support the harvest of a 70 mm all-soft-tissue graft without potentially injuring muscle tissue. Technique Description: Quadriceps tendon length and morphology can be readily assessed by ultrasound. This video demonstrates an easy new method for measuring quadriceps tendon morphology using handheld ultrasound devices that takes <1 minute. Results: This information provides surgeons with knowledge and tools to customize graft harvest to avoid quadriceps muscle injury. Discussion/Conclusion: Avoiding the removal of the quadriceps muscle during graft harvest reduces the role that donor-site morbidity can play in compromising quadriceps recovery after ACLR. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.