this is a lot of fun because I get to go against my friend Pat. My disclosures that they are significant and also it's gonna be biased because I'm fighting one side of the argument. My disclaimer is I'm not a hater. I trained at Pitt. We did mostly hamstrings. The Stedman Hawkins 50% hamstrings. In practice I did greater than a thousand hamstrings in my from 2000 to 2012. My personal life I did a hamstring on my wife when she was my ex-girlfriend at the time. It's a long story but she complains of numbness and weakness still. I'm an evolutionist though because I look at data and I think it's important to look at data to make the you know to make your evolution in this in this area. Ten reasons the quad tendon is the future. Number one collagen. 20% more collagen per cross-sectional area than the quote gold standard end quote patella tendon. That's significant. It's massive. There's a picture of the quad on the left as you take off the muscle. It's a very wide wide tendon. How about the thickness? We published this in AJSM. It's about 1.8 times as thick as your same patella tendon. Okay so think about that too. Predictability. We've all been there. You harvest a hamstring and it's tiny. Whether you got this this big bodybuilder on the right or the little Kenyan runner. What do you do then? We know about the Duke study. It's the fear we have. So the quad tendon is easily predictable pre-op. Okay we know from my study that we did in AJSM that if you take the tip of the rectus to the tip of the patella that the graphs going to be greater than 7 centimeters 90% of the time in someone over 5 feet male or female. If you want a longer graph which you shouldn't really need but if you do you can just take the rectus and reflect it you can see the tendon goes 2 to 3 centimeters up further. So you can get any length you want. We know the thickness is 1.8 so we can figure out the volume easy. If you want to figure out you're doing a revision you want to figure out what size you want the length times widths times depth. That's a pre-op MRI and we standard go 3 centimeter above and there's no difference in the distal 6 centimeters of the tendon. It's good for all ages from these little guys here to the big guys. We published this in AJSM in 15. The average six-year-old 5.5 centimeters in length 3.2 millimeters thick. That's the same thickness as your patella tendon. Okay number five morbidity of graft harvests. We know that hamstrings you get significant weakness after two years we've seen that in multiple studies. With quad you get weakness too with the quad but you do in patella tendon in the hamstring and the allograft. We published this in ESCA where we're equal to patella tendon at 6 and 12 months but by one year LSI is less than 10%. We published in 2007 on my hamstring data my residents did this without me knowing it 74% of the hamstring HCLs had sensory defects greater than four years post-op all in the saphenous nerve distribution. My wife has it also. Harvest time it's the fastest. Infection rate the moon group shows hamstrings at 1.27 percent. Miletus was from Kaiser which is a huge study 0.61 percent. We just finished this it's not submitted to a journal yet of my fourteen hundred and ten quad single surgeons single surgery center. We had two harvest site infections one was culture positive the other just had a was leaking. We had two washouts of joints none of them had positive cultures and they're less than 20,000 white blood cells but in the moon criterion those all count as infections and our rate is 0.28 percent. So you see significantly better than what we see in the hamstring. Number eight failure rate systematic reviews no difference in failure compared to patella tendon but superior to hamstring in each of these systematic reviews. Direct comparison Christian Fink in 2020 published an AJSM prospective study experience surgeon anatomic technique 875 patients hamstring 2.7 times the failure weight rate of the quad tendon. That's a direct comparison. Number nine good for revision surgery we published this this year in arthroscopy mean age 22 very important when you're looking at revisions 20% second or third revisions male female almost equal. We can get in tunnels that are eight to twelve millimeters so you can fill almost any defect. We use a single piece of tissue not one that's wrapped up and failure rates are consistent with PT outcomes with patella tendon outcomes and also with the moon outcome data. Number ten flawed interpretation this is what everyone points to this Martin Lin and Marcus Strauss that showed a high failure rate with quads but look at it they were recruited between 2005 and 12 there were non anatomic ACLs we didn't have a standard quad harvest technique we didn't have the implants and it's a government database and no control of surgeons and patients. They redid this study and basically this year found that if you picked if we do to 2015 and forward if we had a greater than a hundred ACLs done a year at a particular hospital there's a 2.9 percent failure rate versus less than a hundred there's a 6.4 percent failure rate so that the quad is the future Pat take it away

quad tendon

ACL surgery

benefits

collagen content

patient sizes