QUAD TENDON ACL GRAFTS · Built To Perform: Daru Strong

QUAD TENDON ACL GRAFTS

Why are we doing quad tendon ACL grafts?? Let’s talk about it.

This might ruffle some feathers, but it’s a conversation our profession needs to have.

Getting the quad back to full symmetry after ACL reconstruction is already hard enough with traditional grafts. And we know why it matters: the quad controls frontal plane motion, and a weak quad means higher reinjury risk and a hard ceiling on athletic performance. With traditional grafts, it takes serious diligence early in PT to get that quad firing and keep building from there. Throw in BFR, NMES, and aggressive inflammation and pain control, and we’ve made real progress as a profession.

Then the quad tendon graft showed up.

Talk to any experienced high-level sports PT and you’ll hear the same story lmassive quad deficits. And when you think about it, this tracks. The quad was already a fight to recruit when we pulled from the patellar tendon. Now we’ve moved the harvest site even closer to the contractile tissue, right below the musculotendinous junction, creating more scarring and more pain exactly where we need the quad to fire. No wonder it doesn’t want to turn on.

The research is finally confirming what clinicians have been saying in the trenches for years quad tendon grafts don’t return to full strength for TWO YEARS.

So here’s my question. Why is the quad tendon becoming the graft of choice when we’re seeing this kind of deficit? Is this decision truly driven by what’s best for outcomes, athlete health, and long-term joint health? Or are we chasing a trend without fully reckoning with the cost?

I want to hear from this community. Surgeons, PTs, athletic trainers what are you seeing in your clinics?

For ACL reconstruction in competitive athletes, what’s your view on the quad tendon graft?

Surgeons, PTs, ATs, S&C coaches & sports medicine professionals — vote and drop your reasoning below.

Are we choosing the best graft for the athlete—or simply the graft that’s gaining momentum?

🟢 Strong option — benefits outweigh the strength deficits

🟡 Depends on the athlete — graft choice should be individualized

🔴 Concerned — quad strength deficits are too significant

🔵 Need more long-term data — too early to make it the preferred choice Surgeons, PTs, ATs, S&C coaches & sports medicine professionals — vote and drop your reasoning below.

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QUAD TENDON ACL GRAFTS