Quadriceps Tendon Morphometry in Latin American Population and its feasibility as an autograft for Anterior Cruciate Ligament Reconstruction: An Observational Study

Background: Anterior cruciate ligament (ACL) reconstruction requires grafts with predictable morphometry to optimize surgical outcomes and avoid graft-tunnel mismatch. While the quadriceps tendon (QT) has emerged as a reliable alternative globally, high-quality morphometric data for Latin American populations is scarce, potentially limiting its adoption over traditional bone-patellar tendon-bone (BPTB) or hamstring tendon (HT) grafts. This study aims to characterize QT morphometry in a Latin American population using MRI to assess its clinical feasibility. Methods: A retrospective case series was conducted on 78 adults. Morphometric assessment of the QT was performed using Xero software, adapting established measurement protocols. Three independent observers performed the measurements to evaluate reliability. Inter-observer reliability was assessed via the intraclass correlation coefficient (ICC). Anthropometric correlations were analyzed using linear regression models. Results: The cohort included 34 males and 44 females (mean age 52 years; mean height 165 cm). The mean QT length was 70.82 ± 11.09 mm. Although a statistically significant relationship was found between patient height and tendon length (p < 0.05), the correlation was too weak to serve as a robust predictor for graft sizing. Inter-observer reliability for QT measurements was high (ICC = 0.83). Conclusion: Latin American QT morphometry is predictable and reproducible, supporting its feasibility for primary ACL reconstruction. The reliability of MRI measurements validates its utility for preoperative planning. However, the weak correlation with anthropometric variables suggests that preoperative MRI planning is essential, as height alone is an unreliable predictor of graft dimensions. Level of evidence: IV, retrospective case series.