Comparative Biomechanical Strength of Autografts for Ligament Reconstruction: Quadriceps, Rectus Femoris, Peroneus Longus, Patellar, Hamstring quadruple, Hamstring braided, and Iliotibial Band.

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 compared among groups using one-way ANOVA with Tukey’s post hoc analysis (α = 0.05). Results: Significant between-group differences were observed (p < 0.001). The full-thickness quadriceps tendon demonstrated the highest ultimate load (2302.9 ± 79.7 N), significantly exceeding all other grafts. The peroneus longus tendon showed high resistance (1991.3 ± 160.3 N), greater than patellar, hamstring-parallel, rectus femoris, and ITB grafts (p < 0.01). Patellar (1734.7 ± 136.2 N), rectus femoris (1713.9 ± 56.1 N), and hamstring-parallel (1683.8 ± 80.5 N) grafts exhibited comparable strength (p > 0.05). Braided hamstrings demonstrated an 8.2% increase over parallel hamstrings (1821.8 ± 11.7 N vs 1683.8 ± 80.5 N), though not statistically significant. The ITB demonstrated the lowest resistance (749.1 ± 155.4 N; p < 0.001). Conclusion: All autografts tested, with the exception of the iliotibial band, demonstrated biomechanical adequacy for knee ligament reconstruction with respect to ultimate load to failure. The full thickness quadriceps and double strand peroneus longus tendons exhibited the greatest mechanical strength, while the double strand rectus femoris and braided quadruple strand hamstring configurations showed similar properties to patellar tendon and parallel quadruple strand hamstring.