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Introduction

ACL or anterior cruciate ligament reconstruction with a quadriceps tendon autograft is a surgical procedure to replace or reconstruct a torn ACL ligament of your knee with part of the quadriceps tendon taken from your own leg. The quadriceps tendon is a thick tissue located above the patella or kneecap. The goal of ACL reconstruction surgery is to tighten your knee ligament and restore its stability.

Anatomy

The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee, running from the femur to the tibia. The ACL is one of the four major ligaments of the knee that connect the femur (thighbone) to the tibia (shinbone) and helps stabilize your knee joint. When this ligament tears, unfortunately, it does not heal on its own and often leads to the feeling of instability in the knee, requiring reconstruction with a tissue graft to correct the abnormality.

Indications

An ACL tear is the main indication for reconstruction with a quadriceps tendon autograft. The tear may occur as a result of:

  • Sudden directional change while running
  • Sudden slowing down while running
  • Landing incorrectly from a jump
  • A direct blow to the side of your knee, such as during a football tackle

When you injure your ACL, you might hear a loud "pop" sound and may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction.

Preparation

Preoperative preparation for ACL reconstruction with a quadriceps tendon autograft may involve the following:

  • A thorough history and physical examination
  • Routine blood work and imaging
  • Refraining from blood thinners, aspirin, or NSAIDs
  • Informing your doctor of any allergies to medications, anesthesia, or latex
  • Refraining from solids or liquids at least 8 hours prior to surgery
  • Arranging for someone to drive you home following surgery
  • Signing a consent form after the risks and benefits of the surgery have been explained

Procedure

ACL reconstruction surgery with a quadriceps tendon autograft is usually performed under general anesthesia with a minimally invasive arthroscopic technique. The procedure involves the following steps:

  • Your surgeon will make two small cuts, about 1/4-inch-long, around your knee.
  • An arthroscope is inserted into the knee joint through one of the incisions.
  • An arthroscope is a thin tubular instrument with a camera, light, and a magnifying lens attached at the end that is connected to an external monitor and enables your surgeon to view the inside of the knee joint.
  • Along with the arthroscope, a sterile solution is pumped into the joint to expand it, enabling your surgeon to have a clear view and space to work inside the joint.
  • The torn ACL will be removed using miniature surgical instruments passed through the other incision and the pathway for the new ACL is prepared.
  • Your surgeon makes an incision over the quadriceps tendon and takes out a part of the tendon to prepare the new ACL graft.
  • The arthroscope is reinserted into the knee joint through one of the small incisions.
  • Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint.
  • The holes form tunnels in your bone to accept the new graft.
  • The graft is pulled through the predrilled holes in the tibia and femur.
  • The new quadriceps tendon autograft is then fixed into the bone with screws to hold it in place while the ligament heals into the bone.
  • The scope and the instruments are withdrawn, and the incisions are sutured and bandaged.

Postoperative Care

Following surgery, you will require pain management with medications and ice packs. Incision site care and bathing instructions will be provided. You should refrain from strenuous and heavy lifting activities. A knee brace or immobilizer may be recommended to protect the repair. The healing process may take anywhere from 8 to 12 weeks. You will require the use of crutches until you are able to walk without assistance. A physical therapist will teach you specific exercises to strengthen your leg muscles and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to incorporate into the knee joint.

Risks and Complications

Some of the risks and complications of ACL reconstruction with a quadriceps tendon autograft include:

  • Numbness
  • Infection
  • Blood clots or deep vein thrombosis
  • Nerve and blood vessel damage
  • Failure of the graft
  • Loosening of the graft
  • Decreased range of motion
  • Pain in the knee
  • Repeat injury to the graft

Summary

An ACL injury is a sprain or tear to the anterior cruciate ligament. Young people involved in sports such as basketball, football, soccer, and gymnastics are more prone to ACL injuries due to sudden changes in direction, acceleration, deceleration, and repetitive movements. Harvesting a quadriceps tendon autograft to reconstruct the ACL can help individuals and athletes return to their normal activities and sports without any functional limitations.

  • American Academy of Orthopaedic Surgeons
  • Arthroscopy Association of North America
  • American Orthopaedic Society for Sports Medicine
  • South Carolina Orthopedic Association
  • Carolina Forest High School
  • Coastal Carolina