Why More Athletes Are Choosing the Quad Tendon Graft for ACL Reconstruction

For athletes facing ACL reconstruction, the choice of graft is a critical decision that can impact recovery, performance, and long-term knee health. While patellar tendon and hamstring grafts have traditionally been the go-to options, the quadriceps tendon graft is gaining traction as a strong, reliable alternative—particularly for young athletes, female athletes, and those with a history of patellar tendon issues.

When reconstructing the ACL, we remove the damaged ligament and replace it with a graft that will serve as the foundation for a new, functional ACL. Historically, the patellar tendon has been widely used because of its low re-tear rate. However, it also comes with an increased risk of post-surgical complications, such as persistent patellar tendinitis and anterior knee pain.

The quadriceps tendon graft offers an alternative that may reduce these risks while providing a strong and durable solution for ACL reconstruction.

Is the Quad Tendon Graft the Right Fit for You?

Consider a Quad Tendon Graft If:

1. You Have a History of Patellar Tendonitis or Anterior Knee Pain.

The patellar tendon graft is a solid choice for ACL reconstruction, but for patients who already experience patellar tendon pain or inflammation, it can exacerbate symptoms. If you have a history of patellar tendinitis, a quad tendon graft may be the better option to avoid prolonged post-surgical discomfort.

2. You Are a Young Athlete (Under 25 Years Old).

Cadaver grafts (allografts) have a significantly higher re-tear rate in younger athletes, making them a less desirable option for this age group. If you are under 25 and looking for a strong, durable graft, the quad tendon is a solid choice.

3. You Have Naturally Loose Joints and Hyperextension.

Athletes with hypermobile joints are at a higher risk of ACL injuries and re-tears. A quad tendon graft may provide better knee stability in this patient population. You may be loose-jointed if:

• You can bend your thumb to touch your forearm.

• Your pinky finger bends back more than 90 degrees at the knuckle.

• Your elbows or knees hyperextend beyond 10 degrees.

• You can place your palms flat on the ground when bending forward.

A score of 7/9 or more on these hypermobility tests indicates joint laxity, making the quad tendon a viable graft option.

4. You Are a Female Athlete.

Female athletes are more likely to experience ACL injuries due to differences in biomechanics and joint laxity. Additionally, many female athletes struggle with patellar tendon irritation. The quad tendon graft may help reduce anterior knee pain while still providing excellent strength and stability.

5. You Have a High-Grade MCL Tear.

If you have a significant MCL tear, using a hamstring graft for ACL reconstruction may not be ideal, as it could compromise medial knee stability. The quad tendon graft is a strong alternative that does not affect the hamstrings or medial knee structures.

Why the Quad Tendon Graft? Less Post-Surgical Tendinitis, More Stability.

A key advantage of the quad tendon graft is the lower incidence of post-surgical tendonitis compared to the patellar tendon graft. Why?

The patellar tendon is positioned between two bones—the patella and the tibia—which can create tension and stiffness during rehabilitation. In contrast, the quad tendon remains attached to the quadriceps muscle, which allows for more flexibility and reduced strain during recovery.

When comparing outcomes, the quad tendon graft performs similarly to the patellar tendon in terms of stability and durability but with fewer complications such as anterior knee pain and scar tissue formation.

Choosing the Right ACL Graft for Your Needs

Every ACL reconstruction case is unique, and the choice of graft should be based on your activity level, anatomy, and personal history. The quad tendon graft offers a strong, reliable option with excellent outcomes, especially for young athletes, female athletes, and those with a history of patellar tendon issues.

If you’re considering ACL reconstruction, discuss your options with an experienced surgeon. At Vail-Summit Orthopaedics & Neurosurgery, Dr. William Sterett specializes in personalized ACL reconstruction techniques that get athletes back in the game—stronger and more confident than ever.