Rebuilding knees with precision: the Quad 2.0 ACL technique uses rectus femoris autograft for stronger, safer ligament reconstruction. For patients undergoing revision ACL surgery or dealing with multiligament injuries, the Quad 2.0 technique offers a cutting-edge solution that combines precision, strength, and surgical efficiency.
This article explores the latest surgical innovation using a single rectus femoris tendon autograft for anterior cruciate ligament (ACL) and double-bundle anterolateral ligament (ALL) reconstruction. The insights presented here are drawn from the detailed study titled The Quad 2.0 Technique: A Single Rectus Femoris Tendon Autograft Solution for Combined Anterior Cruciate Ligament and Double-Bundle Anterolateral Ligament Reconstruction, authored by Drs. Sonnery-Cottet, Alayane, Mouarbes, Pailhe, and Professor Etienne Cavaignac.
For further insights into knee ligament surgery, we invite you to explore the other studies and technical innovations led by Professor Etienne Cavaignac.
ACL reconstruction with rectus femoris tendon autograft has emerged as a viable alternative to traditional graft options, particularly in revision cases. The technique involves harvesting only the superficial layer of the rectus femoris (RF) tendon to create a graft suitable for both ACL and ALL reconstruction.
The primary advantage of this approach is the ability to generate a graft of sufficient diameter and length while minimising donor-site morbidity. Additionally, the procedure eliminates the need for harvesting hamstring tendons or creating additional femoral or tibial tunnels for ALL fixation, which significantly reduces the risk of tunnel convergence.
In this method, the RF tendon is harvested through a 4-cm vertical incision above the patella. The dissection between the RF and vastus intermedius ensures accurate extraction of an 8-cm graft. This autograft is then folded and prepared for insertion.
Traditionally, ACL and ALL reconstructions require multiple grafts and tunnel preparations. The Quad 2.0 technique simplifies this by:
Double-bundle ALL reconstruction using the extra-articular segment of the RF autograft offers a biomechanically stable reconstruction technique, particularly in patients with rotational knee instability. By avoiding secondary tunnels, the procedure enhances anatomical accuracy and graft integration.
The ALL component is fixed using a knotless anchor positioned on the lateral tibia, posterior to the Gerdy tubercle. Both bundles of the ALL are passed under the fascia lata, maintaining the natural anatomic pathway. Fixation is completed in full knee extension and neutral rotation, promoting isometric tension and reducing the risk of graft elongation over time.
This approach also supports better control of internal tibial rotation and reduces failure rates post-ACL reconstruction, as shown in recent studies on combined lateral procedures.
The Quad 2.0 technique is structured to maximise precision while ensuring a reliable outcome. It involves several key steps:
By maintaining anatomical pathways and using a single autograft, the Quad 2.0 technique reduces complications such as anterior knee pain, patellar fracture and donor-site morbidity seen in other ACL reconstruction strategies.
ACL revision surgery candidates benefit most from the Quad 2.0 technique, particularly when hamstring preservation is essential. The postoperative protocol includes:
By retaining hamstring integrity, the technique is especially advantageous in patients with medial collateral ligament injuries requiring preserved valgus stability.
Furthermore, avoiding tunnel collision and using cortical fixation promotes superior graft healing and stability. The procedure aligns with Professor Cavaignac's practice philosophy, which emphasises precision, anatomical respect and functional recovery.
The Quad 2.0 technique marks a significant evolution in ACL and ALL reconstruction, offering a minimally invasive and effective solution for complex or revision cases. Its anatomical fidelity, graft efficiency and reduced risk profile make it a compelling option for both patients and surgeons.
Surgeons need to be trained in the precise harvesting of the RF tendon to avoid risks such as quadriceps weakness or capsular injury. When performed correctly, however, this technique offers an elegant and powerful solution for complex knee reconstructions.
Recognised for his pioneering research and commitment to excellence, Professor Cavaignac is a trusted authority in knee surgery and sports traumatology.
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