Smaller Width Quadriceps Tendon Grafts Maintain Advantageous Biomechanical Properties for ACL Reconstruction

Background: Despite clinical evidence of risks in knee arthrofibrosis and graft impingement with larger grafts, the optimal size for quadriceps tendon (QT) autografts in anterior cruciate ligament reconstruction (ACLR) has not been established. Purpose/Hypothesis: This study aimed to evaluate the mechanical properties of full-thickness 6-mm and 8-mm wide QT grafts compared with 10-mm patellar tendon (PT) and 10-mm QT grafts. The hypothesis was that both the 6- and 8-mm QT grafts would exhibit similar or superior ultimate tensile strength compared with the 10-mm PT graft. Study Design: Controlled laboratory study. Methods: A total of 18 matched pairs of cadaveric knees were used in this study. From each pair, a 10–mm wide full-thickness QT was harvested from 1 knee. Based on randomization, a 6–mm wide or 8–mm wide full-thickness QT along with a 10–mm wide PT were harvested from the contralateral knee. Each tendon was clamped, tensioned, and cycled on a servohydraulic testing machine before final loading to failure. Results: The ultimate failure load was 1286 ± 237.3 N for the 10-mm QT, 1056 ± 226.7 N for the 8-mm QT, 935.1 ± 283.8 N for the 6-mm QT, and 816 ± 192.7 N for the 10-mm PT. Ultimate tensile strength differed significantly between the 10-mm and 8-mm QT (P =.004), 10-mm and 6-mm QT (P <.001), 10-mm QT and 10-mm PT (P <.001), and 8-mm QT and 10-mm PT grafts (P <.001), but not between the 6-mm QT and 10-mm PT grafts (P =.152). Conclusion: The 8-mm QT had higher ultimate tensile strength than the 10-mm PT, and the 6-mm QT was comparable to the 10-mm PT. Full-thickness QT grafts <10 mm in width may maintain sufficient tensile strength for ACLR. Clinical Relevance: Given these biomechanical properties, smaller QT graft sizes may be advantageous in minimizing arthrofibrosis risk while maintaining graft strength.