# Increasing Utilization of Quadriceps Tendon Autograft in Adult Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Review

## TL;DR

This study shows that the use of quadriceps tendon grafts for ACL reconstruction has increased since 2020, replacing some hamstring tendon grafts at a single institution.

## Contribution

The study provides new evidence of increasing adoption of quadriceps tendon autografts in ACL reconstruction and their inverse relationship with hamstring tendon use.

## Key findings

- Quadriceps tendon autograft use increased annually starting in 2020 at the study institution.
- Quadriceps tendon use was inversely correlated with hamstring tendon use among all surgeon cohorts.
- Non-sports-trained surgeons showed a strong inverse correlation between quadriceps and hamstring tendon use.

## Abstract

Introduction

Recent literature has demonstrated that the use of quadriceps tendon (QT) autograft for anterior cruciate ligament reconstruction (ACLR) is a viable alternative to more well-established autograft options. This study evaluated trends in QT autograft utilization in primary ACLR at a single institution.

Methods

A retrospective review of 2,352 ACLRs from 2014 to 2022 identified 1,582 primary ACLRs using autograft, after excluding allograft (651) and revision cases (119). The cohort included 1,021 men (66%) and 526 women (34%) with an average age of 24.0 years (range, 9-66). Time series analyses assessed annual quadriceps tendon utilization, and Pearson correlations identified trends, with significance defined as p<0.05.

Results

QT autograft was utilized in 3.7% (58/1,582) of autograft ACLR procedures and was used at least once by 29.7% (22/74) of surgeons. QT autograft was not utilized prior to 2020. Beginning in 2020, both the annual proportion of cases that utilized QT and the annual proportion of surgeons who utilized QT increased each year among all surgeon cohorts. QT utilization and hamstring tendon (HT) autograft utilization were inversely correlated among overall surgeons (R=-0.999, p=0.02) and among non-sports-trained surgeons (R=-0.999, p<0.01). HT autograft utilization decreased after the adoption of QT autograft at the study institution among sports-trained surgeons (R=-0.998, p=0.037).

Conclusion

Quadriceps tendon utilization for primary anterior cruciate ligament reconstruction has increased at a single institution since 2020 and corresponded with declining hamstring tendon use across surgeon cohorts with varying training, experience, and case volumes.