Abstract
Purpose
The purpose of this study was to evaluate the anatomical structure of the quadriceps tendon in detail for use as an anterior cruciate ligament (ACL) graft tendon.
Materials and methods
Sixteen cadaveric knees with an average age of 78.8 were used. After careful dissection of skin and fascia, the muscle structure of each quadriceps was evaluated. In particular, the rectus femoris (RF) tendon was measured at its widest and narrowest width, the distance between widest or narrowest point and the proximal end of the patella, and the length.
Results
The quadriceps tendon consisted of three layers. At the surface layer, the RF tendon existed mostly independently. The middle layer consisted of the vastus lateralis (VL) and medialis (VM) tendons. The deep layer consisted of the vastus intermedius (VI) tendon. The VL and VI tendons overlapped and were firmly connected, constituting the strength and size of the quadriceps. The narrowest width of the RF was 15.3 mm, and the narrowest point existed 4.8 mm proximal to the upper end of the patella. The average length of the RF was 27.3 cm.
Conclusion
If the RF tendon only is used as an ACL graft, surgeons should be cautious of the fact that the narrowest point of the RF tendon is located close to the patella. The entire quadriceps tendon is big enough to be used as an ACL graft. However, since the direction of the VL and VI tendons is different, the suitability of the quadriceps tendon as an ACL graft is questionable.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ACL:
-
Anterior cruciate ligament
- RF:
-
Rectus femoris
- VI:
-
Vastus intermedius
- VL:
-
Vastus lateralis
- VM:
-
Vastus medialis
References
Adams DJ, Mazzocca AD, Fulkerson JP (2006) Residual strength of quadriceps versus patellar tendon after harvesting a central free tendon graft. Arthroscopy 22:76–79
Becker I, Baxter GD, Woodley SJ (2010) The vastus lateralis muscle: an anatomical investigation. Clin Anat 23:575–585
Chen CH, Chuang TY, Wang KC, Chen WJ (2006) Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon autograft: clinical outcome in 4–7 years. Knee Surg Sports Traumatol Arthrosc 14:1077–1085. doi:10.1007/s00167-006-0111-0
Clark JC, Rueff DE, Indelicato PA, Moser M (2009) Primary ACL reconstruction using allograft tissue. Clin Sports Med 28:223–244
Droqset JO, Strand T, Uppheim G, Odegard B, Boe A, Grontvedt T (2010) Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicentre review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 18:1085–1093
Feller JA, Webstar KE, Gavin B (2001) Early post-operative morbidity following anterior cruciate ligament reconstruction: patellar tendon versus hamstring graft. Knee Surg Sports Traumatol Arthrosc 9:260–266
Geib TM, Shelton WR, Phelps RA, Clark L (2009) Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy 25:1408–1414
Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC (2005) Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstrings tendon autograft. Arthroscopy 21:791–803
Gorschewsky O, Klakow A, Putz A, Mahn H, Neumann W (2007) Clinical comparison of autologous quadriceps tendon (BQT) and the autologous patella tendon (BPTB) for the reconstruction of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 15:1284–1292
Hadjicostas PT, Soucacos PN, Berger I, Koleganova NK, Paessler HH (2007) Comparative analysis of the morphologic structure of quadriceps and patellar tendon: a descriptive laboratory study. Arthroscopy 23:744–750
Harner CD, Vogrin TM (2002) What’s new in sports medicine. J Bone Joint Surg Am 84:1095–1099
Herrington L, Wrapson C, Matthews M, Matthews H (2005) Anterior cruciate ligament reconstruction, hamstrings versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery. Knee 12:41–50
Kim DW, Kim JO, You JD, Kim SJ, Kim HK (2001) Arthroscopic anterior cruciate ligament reconstruction with quadriceps tendon composite autograft. Arthroscopy 17:546–550
Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T (2008) Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in 328 consecutive patients. Am J Sports Med 36:1675–1687
Lee S, Seong SC, Jo H, Park YK, Lee MC (2004) Outcome of anterior cruciate ligament reconstruction using quadriceps tendon autograft. Arthroscopy 20:795–802
Oro FB, Sikka RS, Wolters B et al (2011) Autograft versus allograft: an economic cost comparison of anterior cruciate ligament reconstruction. Arthroscopy 27:1219–1225
van Eck CF, Illingworth KD, Fu FH (2010) Quadriceps tendon: the forgotten graft. Arthroscopy 26:441–442
Van Eck CF, Schreiber VM, Liu TT, Fu FH (2010) The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1154–1163
Willan PL, Ransome JA, Mahon M (2002) Variability in human quadriceps muscles: quantitative study and review of clinical literature. Clin Anat 15:116–128
Conflict of interest
The authors received no funding support for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Iriuchishima, T., Shirakura, K., Yorifuji, H. et al. Anatomical evaluation of the rectus femoris tendon and its related structures. Arch Orthop Trauma Surg 132, 1665–1668 (2012). https://doi.org/10.1007/s00402-012-1597-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-012-1597-1