ACL Reconstruction with Quadriceps Tendon Autograft

Overview

Quadriceps tendon autograft uses a strip of the patient's own quadriceps tendon, taken from just above the kneecap, to rebuild a torn ACL. Dr. Raffo, who performs a high volume of ACL reconstructions for patients across Montgomery County and the Bethesda area, uses quadriceps tendon as his default graft for most primary reconstructions in active patients under 30 because of its favorable failure-rate profile and low donor-site morbidity.

How Dr. Raffo Performs This Procedure

The quadriceps tendon graft is harvested through a small incision above the kneecap, typically taking a partial-thickness strip of tendon with or without a small bone block from the patella. The native ACL remnant is debrided arthroscopically, femoral and tibial tunnels are drilled, and the graft is passed and fixed under tension, reproducing the ligament's native footprint. The knee is inspected for meniscal tears at the same time, since concomitant meniscal injury is common at ACL reconstruction. If risk factors for graft failure are present, a lateral extra-articular tenodesis may be added through a separate small incision in the same setting.

Who Is This For?

• Most active patients under 30 undergoing primary ACL reconstruction are reasonable candidates for a quadriceps tendon graft, including athletes returning to pivoting and cutting sports.
• Patients concerned about kneeling pain or anterior knee discomfort — a common tradeoff with patellar tendon grafts — are often steered toward quadriceps tendon.
• Patients with a very thin or previously harvested quadriceps tendon, or those who have already had a quadriceps tendon graft on the same knee, are not candidates and need an alternative autograft or allograft.
• High-level contact and collision athletes, and revision surgery patients, are more often steered toward bone-patellar tendon-bone; see the BPTB autograft page for that discussion.

Recovery & Rehabilitation

Recovery follows the same criteria-based framework used for all ACL grafts. Early active motion and weightbearing begin immediately after surgery. Open-chain quadriceps strengthening is delayed for the first several weeks to protect the healing quadriceps tendon donor site as well as the graft, and progressive closed-chain strengthening follows.

• Weeks 0–2: Early motion and weightbearing; swelling control; focus on regaining full extension.
• Weeks 3–6: Closed-chain quadriceps strengthening; open-chain quadriceps exercise avoided during this window.
• Weeks 8–16: Return to running once pain, motion, and strength criteria are met, typically at 8 to 10 km/h (Rambaud et al., BJSM 2018).
• Months 6–9: Sport-specific agility work and formal strength and hop testing.
• Month 9 and beyond: Return to cutting and pivoting sport only after passing a strength and hop-test battery (Grindem et al., BJSM 2016).