Quadriceps tendon autograft for ACL reconstruction: A global survey from the International Quadriceps Tendon Interest Group.

Abstract

To evaluate current preferences, techniques and indications regarding the use of the quadriceps tendon (QT) autograft for anterior cruciate ligament reconstruction (ACLR) among members of the International Quadriceps Tendon Interest (IQTI) group. An online survey consisting of 30 single- and multiple-choice questions was distributed to all IQTI members (<i>n</i> = 45), representing an international group of orthopaedic surgeons with specific expertise in QT-based ACLR. The survey was conducted in conjunction with the second IQTI meeting, and responses were collected over a 2-month period (June-July 2025). Thirty-two high-volume, experienced surgeons completed the questionnaire (32/45; response rate, 71%; 28 male and 4 female). The QT was the preferred primary graft choice for ACLR in 61% (<i>n</i> = 20) of respondents, while 89% (<i>n</i> = 28) used it for revision ACLR and 72% (<i>n</i> = 23) for multiligamentous injuries. Preoperative QT measurement with magnetic resonance imaging (MRI) or ultrasound was performed always or often by 34% (<i>n</i> = 11). Tendon defect closure after harvest was routinely performed by 94% (<i>n</i> = 30), and 33% (<i>n</i> = 11) reported always or often harvesting a bone block. Adjustable-loop suspensory fixation was most commonly used on the femoral side (61%, <i>n</i> = 20), whereas tibial fixation was most frequently achieved with interference screws (72%, <i>n</i> = 23). One-third of surgeons (33%, <i>n</i> = 11) reported modifying their rehabilitation protocol when using QT compared with other grafts. The most frequently observed short-term complications were transient quadriceps weakness and extensor lag. This international survey shows that the QT autograft is a well-established option in ACLR among experienced knee surgeons, particularly in revision and complex settings. At the same time, persistent variability in primary graft selection and reported rehabilitation and technical considerations indicate that QT use remains individualized within a spectrum of effective autograft choices. Level V, expert statement.