Richard Cunningham, MD is a board-certified orthopedic surgeon and sports medicine specialist at Vail-Summit Orthopaedics & Neurosurgery. Dr. Cunningham has advanced training in the treatment of ACL injuries, and he has performed many thousand ACL surgeries over the last 20 years. Dr. Cunningham was one of the first surgeons in Rocky Mountain region to utilize autologous (harvested from the patient) quadriceps tendon grafts for ACL reconstructions starting  ten years ago. This graft choice is backed by strong research as it provides superior results compared to other tendon graft options.

Dr. Cunningham’s expertise and patient-centered care ensures the best possible treatment plan for all patients suffering from an ACL injury. Patients ask, “am I a good candidate for ACL reconstruction using a quadriceps tendon graft?” Committed to patient education, Dr. Cunningham wants patients to have the information they require to answer this important question.

Ideal Patient for Quadriceps Tendon Graft ACL Reconstruction

The quadriceps tendon graft is thicker and stronger than other ACL reconstruction graft options, including the patellar tendon graft and the hamstring tendon graft. Orthopedic research has found that utilizing the central portion of one’s quadriceps tendon provides a more robust ACL surgical repair. The ideal quad tendon graft candidate is:

• Physically active with a desire to return to cutting and pivoting activities
• Athletes less than 40 years of age, particularly females with a history of pain around the knee cap or with smaller hamstring tendons
• History of prior failed ACL knee surgery using other graft options
• Generalized ligamentous laxity with subjective feelings of knee instability

Patients with osteoarthritis and other degenerative conditions of the knee may not be good candidates for ACL surgery utilizing a quadriceps tendon graft. Patients over the age of 50 who do not participate in cutting and pivoting sports may also not be good candidates.

Together with his patient, Dr. Cunningham develops an individualized treatment plan tailored to address the patient’s unique needs, goals, medical history, and physical examination findings. Whenever indicated, ACL reconstruction using an autologous quadriceps tendon graft is Dr. Cunningham’s preferred treatment for active patients who have sustained an ACL tear.

What is the Quadriceps Tendon Graft ACL Reconstruction

During an ACL reconstruction surgery utilizing a quadriceps tendon graft, patients undergo a femoral nerve block by the anesthesiologist. A catheter (tiny tube) is placed and a pain pump infuses numbing medicine around the femoral nerve for 3-5 days. The patient also undergoes a light general anesthetic. An arthroscope (about the size of a pencil) is inserted into the knee through several tiny incisions. The torn ACL is removed and the attachment sites of the ACL are identified. Any meniscal tears or other damage to the knee is repaired. A one inch incision is made above the knee cap. The quadriceps tendon is exposed. The central portion of the tendon is removed. This is the tendon graft and it measures approximately 2 inches long and a half inch wide. This graft has strong stitches passed through each end. The graft is sized to see how large sockets in the knee need to be made in the knee. The graft commonly measures 10mm in diameter.

If the graft measures 10mm in diameter, then 10mm sockets are drilled exactly where the original ACL attached to the femur above and to the tibia below. The ACL graft is seated into these sockets held in place by this strong stitch material anchored to two separate, small metal buttons that are about half the size of a penny. The graft is appropriately tensioned so as to remove any slack in the graft. The small incisions are closed. Cotton dressings and a knee brace is applied. Physical therapy is started immediately after surgery, with patients having formal hour long appointments 2-3 days a week and then doing exercises on their own the other days of the week.

Benefits of ACL Reconstruction Using a Quadriceps Tendon Graft

Dr. Cunningham highlights the clinical advantages of utilizing a quadriceps tendon graft for ACL reconstruction. These include:

• Robust graft: A quadriceps tendon graft is 88% thicker than a patellar tendon graft. Because a quadriceps tendon possesses more collagen than a patellar tendon graft, it is stronger and more closely resembles the size of one’s original ACL. Good biomechanical properties and high tensile strength support accelerated rehabilitation and a return to high demand activity.
• Living Tissue: Utilizing a portion of one’s own quadriceps tendon allows for fast and predictable incorporation of their graft into the femur and tibial bone sockets. Over time, the body also grows blood vessels and nerves into the graft making it a living tissue. This is not seen with the use of donor tendons used to reconstruct ACL’s which leads donor tendons to stretch out and/or re-tear at a higher rate over time.
• Lower incidence of Kneeling Pain Compared to a Patellar Tendon Graft: Patellar tendon grafts are good grafts for ACL reconstruction, but there are advantages of using a quadriceps tendon graft compared to a patellar tendon graft. Because the patellar tendon is a short tendon, the surgeon has to take a one inch long segment of bone from the patella and another segment of bone from the tibia to make the patellar tendon graft long enough to utilize. Taking these segments of bone along with the attached tendon has been shown to increase the incidence of kneeling pain and pain around the knee cap, and this pain can be permanent. There is also a higher risk of fracturing one’s patella if one were to fall on the front of the knee as the patella has been weakened by removing a segment of bone from it.
• Lower incidence of ACL graft re-tear: Studies have shown that donor tendon ACL’s and hamstring ACL’s re-tear at a higher rate compared to an ACL reconstruction utilizing a quadriceps tendon graft.
• Great option for Revision ACL Surgery: If someone who has had prior ACL surgery has re-torn their ACL graft, providing them with an ACL reconstruction utilizing a quadriceps tendon autograft provides them with the highest chance of success and lowest re-tear rates.

Committed to the best treatment for ACL tears, Dr. Cunningham provides expert, compassionate and personalized care for ACL knee reconstruction patients. His experience ensures that each patient eligible for the quadriceps tendon graft ACL reconstruction will receive the innovative treatment and its excellent clinical outcomes. Request a consultation with ACL expert, Richard Cunningham, MD today. In Vail, CO (970) 476-2451, in Frisco (970) 668-3633, and Edwards (970) 569-3240.