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5 Reason Females Should ConsiderThe Quad Tendon Graft for ACL Tear Repair

by Dr. Bill Sterett

More And More Female Athletes Are Opting To Use The Quad Tendon Graft In Reconstructing The ACL.

When we fix an ACL, we actually have to take out the old ACL and put something new in to replace it. You may have heard of the patellar tendon graft. Historically, this type of graft has been the most widely used. And it still is. But we have a newer, intriguing option for reconstructing the ACL that may give us beneficial outcomes. And that's the quad tendon graft.

Why is the quad tendon graft becoming a more desirable option? Well, the patellar tendon grafts have had a significantly higher incidence of prolonged patellar tendinitis after surgery. Almost 1 in 10 have to delay their return to sport because of this issue. There has also been a reported higher incidence of scar tissue and subsequent arthritis with the use of the patellar tendon.

So why use it the patellar tendon graft at all? Because of a lower incidence of re-tearing when compared to the hamstring or a cadaver graft.

Why Should Female Athletes Consider the Quad Tendon for ACL Repair?

Here are 5 Reasons Female Athletes Should Consider the Quad Tendon Graft for ACL Repair

Consider the Quad Tendon graft for your ACL reconstruction if:

1. You Already Have A History Of Patellar Tendonitis Or Patellar Tendon Issues.

In this case, use of a patellar tendon graft can aggravate this and may not be the best graft choice. Consider the quad tendon graft. 

2. You are a Young (under 25) Athlete

Cadaver grafts have an unacceptably high re-rupture rate in this group. If you are under the age of twenty five, consider the quad tendon graft.

3. You Are Congenitally Loose Jointed And Prone To Hyper-Extension

Here's how to tell if you are loose-jointed:

1. Can you bend your thumb down to touch the front of your forearm?

2. Can you bend your pinky finger back more than 90 degrees at the knuckle?

3. Do your elbows hyperextend more than 10 degrees?

4. Do your knees hyperextend more than 10 degrees?

5. Can you touch your palms flat on the ground when you bend over to touch the ground?

With the first four of these having a right and left component, there are a total of 9 points possible. A score of 7/9 or more means you are congenitally loose jointed!

4. Your Are A Female Athlete.

Perhaps because it is more common for females to be loose-jointed and have patellar tendonitis, we will recommend the quad tendon graft more often for our female athletes.

5. You Have A High Grade MCL Tear.

There are concerns about using a hamstring graft in athletes with a significant tear to their MCL, as the graft we utilize may help stabilize the medial side (inner) of the knee in conjunction with the MCL.
So Why Does The Quad Tendon Graft For ACL Reconstruction Have A Lower Incidence Of Post Surgical Tendinitis?

Most likely, it is because the tendon is attached to the elastic quadriceps muscle above while the patellar tendon is suck between two bones, the patella and the tibia, giving it much less pliability or give, during our rehab exercises.

If you can have similar outcomes between the patellar tendon and quad tendon grafts for reconstructing the ACL, but have less postoperative complications like scar tissue, arthritis or tendonitis, why wouldn’t you?

So, if you are a female athlete having an ACL reconstruction, certainly consider the quad tendon graft.

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