Optimizing Rehabilitation for Quadriceps Tendon Anterior Cruciate Ligament Reconstruction: A Focused Approach

Anterior cruciate ligament (ACL) injuries are prevalent in the active and athletic communities, with over 200,000 reconstructions performed annually in the United States. While the bone-patellar tendon-bone (BTB) autograft is historically regarded as the "gold standard," its complications, including anterior knee pain and increased osteoarthritis risk, have prompted the exploration of alternative grafts. The quadriceps tendon (QT) autograft has emerged as a promising alternative, offering comparable outcomes in knee stability, functional performance, and patient satisfaction. Despite growing use, rehabilitation protocols specific to QT autografts remain underdeveloped. Existing guidelines, such as those by the American Physical Therapy Association and the Multicenter Orthopaedic Outcomes Network, primarily address BTB and hamstring tendon autografts, leaving a gap in QT-specific postoperative management. This manuscript reviews current evidence on the biomechanical properties and clinical outcomes of QT autografts and identifies unique rehabilitation considerations. Key modalities, including cryotherapy, neuromuscular electrical stimulation (NMES), open kinetic chain exercises, and blood flow restriction training, are evaluated for their role in optimizing early recovery. Special emphasis is placed on quadriceps activation strategies and progressive loading tailored to QTspecific needs. Recommendations aim to bridge current gaps and facilitate evidence-based, graft-specific rehabilitation protocols. This review underscores the importance of advancing personalized rehabilitation approaches to improve outcomes for patients undergoing ACL reconstruction with QT autografts.