Quadriceps tendon graft

[clarky_vl]

hello,

i was wondering if anyone has had the quadriceps tendon graft for their ACL reconstruction, and whether they could help me with some questions?

i will need another revision, and the quadriceps tendon will be the next graft, after having had hamstring harvested from both legs. it (hopefully) wont take place until next june/july as i cant fit it in with school and what not, so i am looking into it now.

i was wondering how hard it was in your oppinion to rehab after having this tendon harvested? and also, how is the graft site feeling now, in comparison to the other leg? any other information about it too would help!

obviously i have researched this, but what i am really interested in is some experiences of those who have had this, i would be really grateful if anyone could help!

thanks,
Vicky

oh, forgot to add that it will be harvested from the bad ACL leg, and i think it will be along with a LARS like my last hamstring one, for extra strength.

[feeny]

Hi Vicky,

I have not had such a procedure done - but when I was researching prior to my procedure I remember reading some negative things about the quad tendon - not so much the quality of the tendon - but more so that a quad once cut is very hard to get back to its full original function.

So in my own case, I formed the opinion that should I need to harvest bits of myself it would be hamstrings first, then if (hopefully not!) more parts are needed I would have opted for patella ligament before cutting up my quads...!

[queeny]

I don't know your history, but if you're having another revision, have they worked out why previous ones have failed?

I'd also go for bone-patella-bone rather than quads and LARS based on what I've read.

[ATsoccergirl]

I agree with Queeny, you need to work out why your reconstructions have failed before going ahead with another reconstruction. If they were from a contact injury, there is not much you can do as that is more bad luck than anything. But if they were from a non-contact injury that you will need to have your knee looked at further, by someone who specializes in rotational injuries to the knee. One of the most common causes for repetitive ACL graft failure (non-contact) is a posterolateral complex injury.

The quad graft is a good choice for a revision as it it a larger graft. It can be harvest with or without (as advocated by Drs. Fulkerson and Morgan) a bone plug. As long as the graft is correctly harvested there is very little impact on quad function. There is also a reduced chance of graft site morbitity, which can be further reduced by not harvesting a bone plug.

Of course your graft options may change if the cause of your graft failures is found.

[clarky_vl]

hi,
thanks for replies. it is all being investigated thoroughly, and ATsoccergirl, i have had the PLC looked at A LOT and it is no different in the bad leg as in the good leg, so thankfully this is not the reason. i had a lot of tests done to my knee the other day, when i was told that the last one had failed, and am now going for an MRI which i hope will find something. no way will i simply go into another recon without some explanation or something. nothing is definite yet, but from my point of view anyway, totally dependent on A LOT of investigating, and my surgeon has been great with this.

but right now, i am interested in graft options. i really dont like the idea of the patellar tendon one, having read it causes more problems with the knee in the long run, as my surgeon agreed. his next choice of graft after hammies are quads, and the LARS will help it with strength, as with my last hamstring one.

feeny, i too have read about the quad being ugh... difficult! after being harvested, and i guess this is what i was wanting to hear about most from someone? there isnt a lot of info around for this as with other grafts, but thanks ATsoccergirl for the info about it having little impact on the quad function, thats good to know.

any other information very welcome!!

thanks, Vicky

[abknee]

Before you go for another op - please can you inform how is it that you have injured your acl. Both of my acl injuries were due to bad football tackles. I have had acl and ,cl recon in left knee going strong for 10 years.

Have you considered an allograft?

[clarky_vl]

hi abknee,
original injury was a minor twist in netball. totally normal, a pivot that kind of went more through my knee, no one even around me, it was the last thing i expected. so all this has stemmed the least traumatic thing you can imagine! hurt like hell though...

no i havent really considered the allograft, i think it would be my final option, if i had no alternatives. they arent really done to much in the UK anyway, but i would rather use my own tissue.

glad yours is holding strong still- hope that continues!

Vicky

[abknee]

I had an allograft done in the UK - Private but they are only used when getting a graft is difficult from your own body.

The NHS is great - too many people knock it but when they see the US system you know that the care given by the NHS is amazing.

Don't worry too much about where the graft is coming from - just make sure the surgeon performing the operation does 3-4 ACL operations per week - the Surgeon is the single biggest factor in the operation not the graft. You could have a titanium graft and if its misplaced then its load bearing is all wrong and you will be having another acl operation again.

[jiggy]

I've been a lurker here for a long time, but finally felt compelled to share my experience on this topic

I originally had a hamstring reconstruction on my left knee done in March 07. That graft unfortunately failed during my return to soccer ... I started my return at about 7 months post op, and that only lasted a couple months. The graft tore after a very unfortunate collision during a scrimmage. I had a revision done fairly quickly as soon as the swelling went down from the popped hamstring graft. Based on the doctor's advice, I chose the quad tendon graft over the patellar tendon graft. As background, my doctor is a well known surgeon who specializes in knees & revisions. I also did a lot of research on my own which indicated that the quad tendon is a good choice for a revision, so I was not too nervous about that.

I'm currently at just over 10 months post op on the quad graft, and here are my experiences/observations in chronological order. Keep in mind this is based purely on my experience and may be totally different for you!

- initial pain after surgery was significantly worse than after first surgery - turns out that having a butchered quad is much harder to deal with than having a butchered hamstring - who knew you needed your quad to engage to wiggle your toes ?
- time spent on crutches this time was a bit longer than the first time (around 2 weeks), but mainly as a precaution, not a necessity
- quad muscle loss was much more significant after the second surgery, most likely due to longer period before being able to fully engage the quad muscles again
- after the initial post surgery phase (say over 1 month), pain in quad tendon area was still fairly significant on and off for the next 2 or 3 months, especially when holding leg still in one place, such as driving or sitting at a table during a meal
- recovery of quad muscle takes longer due to prolonged healing of harvest site ... probably took about 6 months to get near full strength, full range of motionback without feeling any pain/tension in the harvest site
- currently feel pretty strong, knee is stable, but still get some nagging pain here and there around the graft harvest site
- muscle mass in the left quad is still less comapred to the unaffected leg, but according to physio, strength is pretty comparable

Overall, you have to be very patient with this graft. My experience is that the graft harvest site requires significant time to heal and return to pain free function. I'd say that I'm finally getting to a point with it where I can say that it was not a bad choice. Up until 9 months or so, I was not a happy camper with overall progress, but hopefully things are looking up for the long term

Hope this helps you with your choice. I'll be happy to fill you in on any other questions as well.

[clarky_vl]

hello,

abknee, i must say that i totally agree with you, from my experiences i have been very impressed with the NHS, they have been really great with me, even the waiting lists have been good! however i would admit that i have been extremely lucky, i know it can be pretty bad in some places!

jiggy, well.... THANKYOU SOOOO MUCH! i really appreciate you telling me that, and thankyou for being so honest about it! i know this one is going to be tougher than the hammie ones if it goes ahead, but i was glad to hear most of all that the strength is now comparable. i have already used my best bits though lol! i am sorry you have had quite a hard time with it, but am really happy that you feel it has been feeling good recently.

i have just thought of another question, was wondering how, if at all, the rehab differed from the hamstring (never knew you needed your quads to wiggle your toes! ouch) with the initial phase? particularly with ROM exercises as i did lots of quad exercises to regain my ROM last time, was this a problem given the graft site pain?

thankyou so much for your help!

Vicky

[LiaPatrik]

I agree with Queeny, you need to work out why your reconstructions have failed before going ahead with another reconstruction. If they were from a contact injury, there is not much you can do as that is more bad luck than anything. But if they were from a non-contact injury that you will need to have your knee looked at further, by someone who specializes in rotational injuries to the knee. One of the most common causes for repetitive ACL graft failure (non-contact) is a posterolateral complex injury.

The quad graft is a good choice for a revision as it it a larger graft. It can be harvest with or without (as advocated by Drs. Fulkerson and Morgan) a bone plug. As long as the graft is correctly harvested there is very little impact on quad function. There is also a reduced chance of graft site morbitity, which can be further reduced by not harvesting a bone plug.

Of course your graft options may change if the cause of your graft failures is found.

why is the patellar tendon not good for revision?