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Background <p>Selecting the optimal autograft for knee ligament reconstruction is a critical factor influencing graft strength, surgical strategy, and postoperative outcomes. Although patellar and hamstring tendons are traditionally preferred, emerging options—including quadriceps, rectus femoris, peroneus longus, braided hamstrings, and iliotibial band (ITB)—have gained attention. However, direct biomechanical comparison under standardized conditions remains limited.</p> Hypothesis <p>It was hypothesized that the four emerging grafts (rectus femoris, peroneus longus, braided hamstrings, and ITB) would demonstrate ultimate load to failure comparable to the three traditional autografts, with potential mechanical advantages for the rectus femoris and peroneus longus tendons.</p> Study design <p>Controlled laboratory biomechanical study.</p> Methods <p>Fifty-eight grafts were harvested from adult cadaveric donors (all male; mean age, 35 ± 5 years). Seven autograft types were evaluated: full thickness quadriceps, double strand rectus femoris, double strand peroneus longus, patellar (soft-tissue portion of the bone–patellar–tendon–bone), quadruple strand hamstring (parallel and braided configurations), and iliotibial band. Each graft was fixed in polyurethane foam blocks with titanium interference screws and tested to failure in a universal testing machine (EMIC DL 10000) at 10 mm/min. Ultimate load to failure (N) was analyzed using a linear mixed-effects model with donor as a random effect to account for within-donor clustering.</p> Results <p>Significant differences in ultimate load to failure were observed among graft types in the linear mixed-effects model (overall <i>p</i> &lt; 0.001). The full-thickness quadriceps tendon demonstrated the highest ultimate load (2302.9 ± 79.7 N), significantly greater than all other graft configurations (all adjusted <i>p</i> &lt; 0.05). The double-strand peroneus longus tendon also demonstrated high resistance (1991.3 ± 160.3 N), with significantly greater ultimate load values than the patellar tendon, double-strand rectus femoris tendon, quadruple-strand hamstring (parallel configuration), and iliotibial band (all adjusted p &lt; 0.05). The patellar tendon (1734.7 ± 136.2 N), double-strand rectus femoris tendon (1713.9 ± 56.1 N), and quadruple-strand hamstring (parallel configuration) grafts (1683.8 ± 80.5 N) demonstrated comparable biomechanical performance (all adjusted <i>p</i> &gt; 0.05). The braided hamstring configuration demonstrated an 8.2% greater ultimate load than the parallel configuration (1821.8 ± 11.7 N vs 1683.8 ± 80.5 N), although this difference was not statistically significant (adjusted <i>p</i> &gt; 0.05). The iliotibial band demonstrated the lowest resistance (749.1 ± 155.4 N), significantly lower than all other graft groups (all adjusted <i>p</i> &lt; 0.05).</p> Conclusion <p>The full-thickness quadriceps and double-strand peroneus longus grafts demonstrated the highest absolute ultimate loads to failure under standardized static testing conditions. The rectus femoris, patellar tendon, and hamstring graft configurations showed comparable biomechanical performance, whereas the iliotibial band demonstrated lower resistance. These findings represent time-zero biomechanical data and should not be interpreted as evidence of clinical superiority of any graft option.</p>

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Comparative biomechanical strength of autografts for ligament reconstruction: quadriceps, rectus femoris, peroneus longus, patellar, hamstring configurations (quadruple and braided) and iliotibial band: an exploratory cadaveric biomechanical study

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  • 发表日期：

    2026年7月14日

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  • Márcio Bezerra Gadelha Lopes,
  • Diego Ariel de Lima,
  • Jonatas Brito de Alencar Neto,
  • Sergio Marinho de Gusmão Canuto,
  • Renata Clazzer,
  • Camilo Partezani Helito,
  • Carlos Eduardo da Silveira Franciozi

摘要

Background

Selecting the optimal autograft for knee ligament reconstruction is a critical factor influencing graft strength, surgical strategy, and postoperative outcomes. Although patellar and hamstring tendons are traditionally preferred, emerging options—including quadriceps, rectus femoris, peroneus longus, braided hamstrings, and iliotibial band (ITB)—have gained attention. However, direct biomechanical comparison under standardized conditions remains limited.

Hypothesis

It was hypothesized that the four emerging grafts (rectus femoris, peroneus longus, braided hamstrings, and ITB) would demonstrate ultimate load to failure comparable to the three traditional autografts, with potential mechanical advantages for the rectus femoris and peroneus longus tendons.

Study design

Controlled laboratory biomechanical study.

Methods

Fifty-eight grafts were harvested from adult cadaveric donors (all male; mean age, 35 ± 5 years). Seven autograft types were evaluated: full thickness quadriceps, double strand rectus femoris, double strand peroneus longus, patellar (soft-tissue portion of the bone–patellar–tendon–bone), quadruple strand hamstring (parallel and braided configurations), and iliotibial band. Each graft was fixed in polyurethane foam blocks with titanium interference screws and tested to failure in a universal testing machine (EMIC DL 10000) at 10 mm/min. Ultimate load to failure (N) was analyzed using a linear mixed-effects model with donor as a random effect to account for within-donor clustering.

Results

Significant differences in ultimate load to failure were observed among graft types in the linear mixed-effects model (overall p < 0.001). The full-thickness quadriceps tendon demonstrated the highest ultimate load (2302.9 ± 79.7 N), significantly greater than all other graft configurations (all adjusted p < 0.05). The double-strand peroneus longus tendon also demonstrated high resistance (1991.3 ± 160.3 N), with significantly greater ultimate load values than the patellar tendon, double-strand rectus femoris tendon, quadruple-strand hamstring (parallel configuration), and iliotibial band (all adjusted p < 0.05). The patellar tendon (1734.7 ± 136.2 N), double-strand rectus femoris tendon (1713.9 ± 56.1 N), and quadruple-strand hamstring (parallel configuration) grafts (1683.8 ± 80.5 N) demonstrated comparable biomechanical performance (all adjusted p > 0.05). The braided hamstring configuration demonstrated an 8.2% greater ultimate load than the parallel configuration (1821.8 ± 11.7 N vs 1683.8 ± 80.5 N), although this difference was not statistically significant (adjusted p > 0.05). The iliotibial band demonstrated the lowest resistance (749.1 ± 155.4 N), significantly lower than all other graft groups (all adjusted p < 0.05).

Conclusion

The full-thickness quadriceps and double-strand peroneus longus grafts demonstrated the highest absolute ultimate loads to failure under standardized static testing conditions. The rectus femoris, patellar tendon, and hamstring graft configurations showed comparable biomechanical performance, whereas the iliotibial band demonstrated lower resistance. These findings represent time-zero biomechanical data and should not be interpreted as evidence of clinical superiority of any graft option.