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Surgeon praises central quadriceps free tendon graft in ACL reconstruction

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KOHALA COAST, Hawaii — Knee surgeons have a variety of grafts to choose from when performing ACL reconstruction, but one surgeon believes the central quadriceps free tendon (CQFT) offers some distinct benefits over other graft materials, including less pain and quicker rehabilitation.

“It’s safe, accessible, the incision can be minimized for cosmetic reasons, and there’s no risk for neurovascular damage,” said John P. Fulkerson, MD, who detailed his experience using the graft at Orthopedics Today Hawaii 2009, here.

“The graft also seems to produce less pain, and many patients who receive it experience faster rehabilitation. Using it allows us to preserve the patient’s hamstrings, and there is no loss of power in flexion,” he added.

Fulkerson, who conducted some of the early research on the graft in ACL reconstruction, said, “You can do whatever side you want, and you have more tendon mass with a CQFT than you do with the patellar bone-tendon-bone (BTB) grafts.”

He tries to acquire and use CQFT grafts that are about 7 mm thick, compared to the patellar tendon grafts, which are typically less than 5 mm.

“I haven’t had any of my patients experience a rupture in 9 years,” he said. “It offers some of the lowest morbidity [rates] among all of the grafts.”

One of the most common reasons for using the CQFT graft is the ability to harvest it safely. “There is no blind cutting of anything; we don’t have to worry about blood vessels,” he said.

Fulkerson said he even used the graft successfully in a few double-bundle ACL procedures.

Researchers have found that using CQFT grafts has restored patients’ range of motion more effectively than some other grafts, and the requirements for pain medication are also less among many patients who receive the CQFT graft, Fulkerson said.

“We have seen no range of motion loss or anterior knee pain in our own 2-year follow-up,” he said.

Reference:

• Fulkerson JP. The central quadriceps free tendon graft for ACLR: Why I like it. Presented at the Orthopedics Today Hawaii 2009 Meeting. Jan. 11-14, 2009. Kohala Coast, Hawaii.