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C. FINK, M. HERBORT, P. GFÖLLER, C. HOSER
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POSTOPERATIVE CARE
While still in the operating room, the knee is
positioned in an extension brace following
application of the wound dressing and a Cryo
cuff.
If the patient is hospitalized, drains are removed
and radiographs are obtained on the first
postoperative day. A 0-0-90° knee brace is
applied, and the patient is mobilized under the
direction of a physical therapist.
Partial weight bearing at approximately
20-30 kg should be maintained for the first
two postoperative weeks. The brace and
crutches can be discontinued by the third
postoperative week. In most cases the patient is
discharged on the second or third postoperative
day and continues outpatient physical therapy
2 or 3 times per week for at least 6 weeks.
In patients with associated injuries and/or
concomitant procedures (torn medial
collateral ligament, meniscus repairs, etc.),
the rehabilitation protocol should be modified
accordingly.
SUMMARY
The quality of the QT is often underestimated
in cruciate ligament surgery. The tendon is
very flexible in its dimensions and can be
used with or without a bone plug. It is
superior to the patellar tendon in donor-site
morbidity, especially with regard to kneeling
[7]. Based on the results of clinical and
biomechanical studies, the QT also appears to
be a suitable graft for primary anatomic
reconstructions of the anterior cruciate
ligament [9]. To date, we feel that a major
obstacle to the widespread use of the QT as a
primary graft is the more technically
demanding harvesting technique and the
frequently poorer cosmetic result. These
disadvantages can be significantly reduced,
however, by the development of a
standardized, minimally invasive technique
for harvesting the graft (fig. 6b).
LITERATURE
[1] CHEN CH, CHUANG TY, WANG KC, CHEN WJ,
SHIH CH. Arthroscopic anterior cruciate ligament
reconstruction with quadriceps tendon autograft: clinical
outcome in 4-7 years.
Knee Surg Sports Traumatol Arthrosc
2006; 14(11): 1077-85.
[2] FINK C, HERBORT M, ABERMANN E, HOSER C.
Minimally invasive harvest of a quadriceps tendon graft with
or without a bone block.
Arthrosc Tech 2014; 3(4): e509-13.
[3] FINK C, HOSER C. Einzelbündeltechnik:
Quadrizepssehne in Portaltechnik.
Arthroskopie 2013;
26(1): 35-41.
[4] GEIB TM, SHELTON WR, PHELPS RA, CLARK L.
Anterior cruciate ligament reconstruction using quadriceps
tendon autograft: intermediate-term outcome.
Arthroscopy
2009; 25(12): 1408-14.
[5] HERBORT M, TECKLENBURG K, ZANTOP T,
RASCHKE MJ, HOSER C, SCHULZE M, PETERSEN W,
FINKC.Single-bundleanteriorcruciateligamentreconstruction:
a biomechanical cadaveric study of a rectangular quadriceps and
bone-patellar tendon-bone graft configuration versus a round
hamstring graft.
Arthroscopy 2013 Dec; 29(12): 1981-90.
[6] HOEHER J, BALKE M, ALBERS M. Anterior cruciate
ligament (ACL) reconstruction using a quadriceps tendon
autograft and press-fit fixation has equivalent results
compared to a standard technique using semitendinosus
graft: a prospective matched-pair analysis after 1 year.
Knee
Surg Sports Traumatol Arthrosc 2012; 20: 147.
[7] LUND B, NIELSEN T, FAUNO P, CHRISTIANSEN
SE, LIND M. Is quadriceps tendon a better graft choice than
patellar tendon? A prospective randomized study.
Arthroscopy 2014; 30(5): 593-8.
[8] SHINO K, NAKATAK, NAKAMURAN, TORITSUKA
Y, HORIBE S, NAKAGAWA S, SUZUKI T. Rectangular
tunnel
double-bundle
anterior
cruciate
ligament
reconstruction with bone-patellar tendon-bone graft to
mimic natural fiber arrangement.
Arthroscopy 2008; 24(10):
1178-83.
[9] SLONE HS, ROMINE SE, PREMKUMAR A,
XEROGEANES JW. Quadriceps tendon autograft for
anterior cruciate ligament reconstruction: a comprehensive
review of current literature and systematic review of clinical
results.
Arthroscopy 2015; 31(3): 541-54.
[10] STÄUBLI HU, SCHATZMANN L, BRUNNER P,
RINCON L, NOLTE LP. Mechanical tensile properties of
the quadriceps tendon and patellar ligament in young adults.
Am J Sports Med 1999; 27(1): 27-34.