Quadriceps tendon autograft: A larger intraoperative diameter for primary anterior cruciate ligament reconstruction in Asian patients

Objectives: The quadriceps tendon (QT) autograft is an increasingly popular choice for primary anterior cruciate ligament reconstruction (ACLR). The primary aim of this study is to determine if QT autografts yielded larger autograft diameters intraoperatively compared to hamstring (HS) tendon autografts after adjusting for height and weight in the Asian population, with a secondary aim to provide recommendations for autograft choice in primary ACLR. Materials and Methods: This is a retrospective study of patients undergoing primary ACLR at a single tertiary center. All consecutive patients with HS autografts and QT autografts from August 01, 2022 to December 31, 2024 were included in this study. Revision ACLRs were excluded. Patients’ anthropometric data and intraoperative autograft diameters were collected, and autograft diameters of QT group were compared with the HS group, after adjusting for age, gender, height, and weight. Results: A total of 151 patients were included, 111 in HS group and 40 in QT group. The mean intraoperative autograft diameter for HS group was 8.15 mm ± 0.60 mm and 9.14 mm ± 0.61 mm for QT group. QT intraoperative autograft diameter was significantly larger than HS autograft by 0.99 mm ( P = <0.001). To obtain an HS autograft width of at least 8 mm, the patient’s height should ideally be >167 cm or weight >65 kg. Conclusion: QT autograft provides a significantly larger autograft size compared to HT autograft in the Asian population after adjusting for height and weight. To obtain an autograft diameter of 8 mm in the Asian population in patients of height ≤167 cm or weight ≤65 kg, harvesting the QT over HS autograft should be strongly considered.