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Pedicled Quadriceps Graft or The Superficial Quad Graft?

      To the Editor:
      We read the article written by Nelitz and Williams
      • Nelitz M.
      • Williams S.R.M.
      Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft.
      with great interest. I must thank both the authors for using the technique in children and adolescents and quoting our original study
      • Goyal D.
      Medial patellofemoral ligament reconstruction: The superficial quad technique.
      of “the superficial quad technique” multiple times.
      However after reading the whole article, I did not find any difference between the superficial quad technique
      • Goyal D.
      Medial patellofemoral ligament reconstruction: The superficial quad technique.
      and the pedicled quadriceps tendon graft technique!
      • Nelitz M.
      • Williams S.R.M.
      Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft.
      The authors showed a smaller incision, which is noteworthy. However, they stated that the pedicled quadriceps graft is a refinement of the superficial quad technique because it sutures the graft at the medial border. This is not correct because our original technique does the same thing as shown in Fig 3C and discussed in step 6 of the original article.
      • Goyal D.
      Medial patellofemoral ligament reconstruction: The superficial quad technique.
      I agree that their description on the use of the superficial quad technique in patients with an open physis is important and has not been previously published by us because we are waiting for the long-term results of similar cases.
      In toto, it remains the same procedure but is used in children. Giving multiple names to the same procedure confuses the readers and the scientific community and takes away the credit from the previous author. It would have been better if the authors had titled their article “The Use of the Superficial Quad Technique in an Adolescent Age Group.”

      References

        • Nelitz M.
        • Williams S.R.M.
        Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft.
        Arthrosc Tech. 2014; 3: e303-e308
        • Goyal D.
        Medial patellofemoral ligament reconstruction: The superficial quad technique.
        Am J Sports Med. 2013; 41: 1022-1029

      Linked Article

      • Anatomic Reconstruction of the Medial Patellofemoral Ligament in Children and Adolescents Using a Pedicled Quadriceps Tendon Graft
        Arthroscopy TechniquesVol. 3Issue 2
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          Reconstruction of the medial patellofemoral ligament (MPFL) has recently become a popular procedure for children and adolescents with patellofemoral instability. Nevertheless, high complication rates of up to 26% have been reported. The traditionally used technique requires patellar bone tunnels that may place the proportionately smaller patella at higher risk of fracture. Because of the adjacent physis of the femoral insertion, anatomic reconstruction of the MPFL has the risk of injury to the growth plate.
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        Open Access
      • Author's Reply
        ArthroscopyVol. 31Issue 5
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          We thank Dr. Goyal for his interest in our article. In agreement with the article by Goyal,1 we believe that the quadriceps tendon provides a valuable graft alternative to the widely used gracilis tendon for reconstruction of the medial patellofemoral ligament, especially in children. We very much appreciate the elegant description of the technique by Goyal,1 which also uses a pedicled quadriceps graft.
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