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    Estimating the adequacy of the free quadriceps tendon autograft length using anthropometric measures in anterior cruciate ligament reconstruction
    (Springer, 2022) Yuksel, Yavuz; Kose, Ozkan; Torun, Ebru; Ergun, Tarkan; Yardibi, Fatma; Sarikcioglu, Levent
    Objective This prospective study aimed to predict the adequacy of free quadriceps tendon (QT) autograft length using simple anthropometric measures. Materials and methods One hundred and eighty-four consecutive patients who underwent knee high-resolution MRI were enrolled in this study. The QT and native anterior cruciate ligament (ACL) length were measured using the oblique sagittal section. The adequate free QT length was calculated using the native ACL length and 30 mm for femoral and tibial tunnels in each patient. A QT shorter than the calculated length was considered inadequate. Age, sex, height, weight, body mass index, thigh circumference, and activity score were used to predict the adequacy of QT length with regression analysis. Results There were 92 men and 92 women with a mean age of 34.1 +/- 8.0 years (range 18-45). The mean QT and ACL lengths were 69.0 +/- 8.8 mm (range 48.1-90.3 mm) and 35.6 +/- 2.5 mm (range 29.2-42.6 mm), respectively. The QT and the ACL lengths were longer in men (p < 0.001 for both). Twenty-three men and 39 women (total: 62, 33.7%) had inadequate QT length for a free QT autograft, and 6 patients (3 males, 3 females, 3.3%) had inadequate QT length with the bone block technique. There was a weak positive correlation between QT length and height (p < 0.001), weight (p < 0.001), and activity score (p = 0.007). Height was the only independent variable that predicted the QT length adequacy (r(2) = 0.051, p = 0.009) but ROC analysis showed that height did not have an ability to detect a subject with an inadequate QT length (AUC: 0.384, 95% CI 0.300-0.468). Conclusions Free QT autografts may be inadequate in one-third of the patients, while a QT autograft with a bone block is almost always sufficient. Inadequate free QT autograft is more common in women. Although QT length correlated with height, it cannot be used as an accurate diagnostic tool to identify patients with an inadequate QT autograft. Preoperative measurement of the ACL and QT lengths by MRI might be beneficial to decide whether QT is usable, especially when harvesting without a bone block.
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    Prevalence of the Peroneus Quartus Muscle and Its Association with Peroneal Tendon Pathologies: An MRI Study of 1160 Ankles
    (Mdpi, 2025) Yuksel, Yavuz; Ergun, Tarkan; Kose, Ozkan
    Background/Objectives: The peroneus quartus (PQ) muscle is a supernumerary muscle in the lateral compartment of the leg. Although frequently asymptomatic, it may contribute to peroneal tendon (PT) disorders due to mechanical crowding in the retromalleolar groove. This study aimed to determine the prevalence of the PQ muscle on MRI and assess its association with PT pathologies. Materials and Methods: This retrospective study evaluated 1160 ankle MRI scans from 1073 patients (mean age, 42.7 +/- 14.5 years; 643 females, 430 males). The presence of the PQ muscle and associated PT pathologies, including tenosynovitis, tendinitis, and tendon tears of the peroneus brevis tendon (PBT) and peroneus longus tendon (PLT), was recorded. Statistical analyses were performed using chi-square tests, and associations were expressed as odds ratios (OR) with 95% confidence intervals (CI). Results: The PQ muscle was identified in 123 of 1160 ankles, corresponding to a prevalence of 10.6%. Its incidence was significantly higher in males (12.7%) than in females (9.2%) (p = 0.018), while the side distribution showed no statistically significant difference. PQ presence was associated with PBT pathology, particularly tendinitis and longitudinal tears, and with PLT tendinitis, whereas no clear association was observed with tenosynovitis or PLT tears. Conclusions: The PQ muscle is a relatively common anatomical variant, present in 10.6% of ankles on MRI scans. Its presence is significantly associated with PT abnormalities, especially PBT tendinitis and tears. Awareness of PQ may aid clinicians and radiologists in assessing lateral ankle pain and peroneal tendon disorders.