Sweet Spot for Quadriceps ACL Autografts: 8-9 mm

There are advantages to quadriceps grafts, but their shape makes sizing them especially important, and it's tricky

What’s the Claim?

A recent large, single-surgeon series found that 7.2% of patients developed localized anterior arthrofibrosis (a “cyclops” lesion) resulting in reoperation to regain terminal extension within six months of soft tissue quadriceps autograft ACL reconstruction. This complication was more common in patients with large (≥ 9.25 mm) femoral tunnels and patients who had meniscal repairs at the same time.

How’s It Stack Up?

Previous studies have not consistently identified female sex as a factor associated with the development of a cyclops lesion and loss of terminal extension after ACL reconstruction, though it makes some intuitive sense that women (or men with narrow intercondylar notch dimensions — or, as here, men who received thicker grafts) might develop this problem.

Thicker grafts have been associated with an increase in the risk of arthrofibrosis, that association being especially dramatic in one study of hamstring and Achilles allografts in younger patients. There’s a narrow needle to thread here, since grafts thinner than 7 to 8 mm have been associated with a higher risk of re-rupture.

What’s Our Take?