Volume 30, Issue 174, August 2026

Comparison of Quadriceps Tendon, Bone-Patellar Tendon-Bone, and Hamstring Tendon Autografts in Primary ACL Reconstruction: A Review of Biomechanics, Efficacy, and Donor-Site Morbidity

Daniel Aduku^1♦, Adam Wojtynek², Erwin Górski³, Stanisław Janczarski⁴

¹Clinic of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology, Chair of Orthopaedics and Traumatology, Medical University of Łódź, Żeromskiego 113, 90-549 Łódź, Poland
²Medical University of Łódź (UMED), Łódź, Poland
³Institute of Dentistry of the Central Clinical Hospital of the Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland
⁴Institute of Dentistry of the Central Clinical Hospital of the Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland

^♦Corresponding author
Daniel Aduku, Clinic of Arthroscopy, Minimally Invasive Surgery and Sports Traumatology, Chair of Orthopaedics and Traumatology, Medical University of Łódź, Łódź, Poland

ABSTRACT

Tearing the ACL is a major setback for athletes, especially those in pivoting sports like skiing and football. For years, surgeons relied almost entirely on BPTB and hamstring grafts. Lately, though, many are shifting toward quadriceps tendon grafts to reduce chronic muscle weakness, stubborn donor-site pain, and high retear rates seen in younger patients. This paper will focus on the analysis of current research on quadriceps grafts and their performance compared with traditional grafts. We analyzed data gathered through a literature search in databases from January 2016 to March 2026. After analyzing data on almost 19,000 cases in registries and trials, one can conclude that quadriceps grafts are as good as traditional grafts in terms of failure rates (around 2.2-3.1%) and joint stability. The primary advantage of the quadriceps graft lies in patient comfort. It reduces anterior knee pain down to 7.2%, a substantial decrease from the 28.4% seen with BPTB grafts. Looking at soft-tissue versus bone-block setups, the outcomes and failure rates look pretty much identical. Also, in children and adolescents, soft tissue quadriceps grafts had a significantly lower risk of rupture (3.5%) compared to hamstrings (12.4%), without compromising growth plate injury. The quadriceps tendon is a versatile and dependable option for primary ACL reconstruction. From our clinical analysis, it is evident that the graft selection should capitalize on these unique features.

Keywords: ACL Reconstruction, Quadriceps Tendon, Bone-Patellar Tendon-Bone, Hamstring Tendon, Donor-Site Morbidity, Pediatric ACL, Return to Sport

Medical Science, 2026, 30, e155ms3947

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Published: 18 August 2026