Twin Soccer Athletes with Simultaneous ACL Tears - Which Graft Would You Chose?

Novel quadriceps tendon autograft enables twin athletes' return to play

Identical twins served as soccer team captains for a charter school in west Phoenix. Both suffered anterior cruciate ligament (ACL) injuries during their junior year soccer season within a five-week period.

One twin tore her ACL during a spring soccer match, and just five weeks later, her sister tore her ACL and meniscus in a practice session. Both girls were evaluated and diagnosed by Heather M. Menzer, MD, orthopedic surgery and sports medicine physician with the Herbert J. Louis Center for Pediatric Orthopedics at Phoenix Children's. MRI confirmed both diagnoses. Within one week of each other, the twins underwent ACL reconstruction surgery.

ACL reconstruction is one of the most common orthopedic surgeries performed. In this setting, one of the most critical surgical decisions is the graft type used in the reconstruction.

Heather M. Menzer, MD

In ACL reconstruction, surgeons typically replace torn ligament tissue with patellar, hamstring, or donor tendons. For females and young athletes, the quadriceps tendon autograft is gaining in popularity.

According to the literature; the quadriceps tendon autograft provides a robust tissue volume for harvesting, reducing the likelihood of variably sized grafts or the need for allograft augmentation. ln fact, the quadriceps tendon has significantly more volume than the patellar tendon and, even after tissue harvest, the remaining quadriceps tendon is still 80% stronger than the intact patellar tendon. The graft is also associated with optimal functional outcomes, low failure rates, and minimal donor site morbidity. 1,2


As a high school athlete, Dr. Menzer had  injuries requiring ACL reconstruction, meniscus repair, and additional knee surgeries. She knew first-hand the importance of restoring function to get athletes back into play while reducing the chance of long-term complications. For these identical athletic twins, Dr. Menzer recommended and performed quadricep tendon autografts.

Dr. Menzer repaired two torn ACLs, one torn meniscus and gave birth to her child just six days later. Both surgical repairs were successful. By the soccer season of their high school senior year, the twins were back on the field leading their team.

"[These two] surgeries hold a special place in my heart,” said Dr. Menzer. "The family and I went through a very unique experience together around the same time my daughter was born.”

Ensuring a complete recovery and safe return to play: Even though the patients were identical twins with similar injuries, no two ACL reconstructions or recovery processes are the same.

"It can take nine months to a year for full recovery following ACL reconstruction, but timing is not always an accurate recovery measure," said Dr. Menzer. "To more precisely guide athletes to a safe return to sports, I like to use Phoenix Children's Motion Analysis Lab.''

The Bubba Watson and PING Golf Motion Analysis Laboratory at Phoenix Children's uses state-of-the-art equipment to measure real 3D motion, force, and muscular activity, enabling healthcare providers to customize post-operative and rehabilitative treatment plans while measuring improvement.

"There is always a risk of reinjury to a reconstructed ACL and determining an athlete's physical readiness is key to reducing that risk;' said Dr. Menzer. "The Motion Analysis Lab enables me to compare the strength, agility, flexibility, and  stability of a patient’s injured and non-injured joint or limb.

Once there is symmetry, I can better recommend a safer return to sport."

Results from Phoenix Children's Motion Analysis Lab also help build confidence in athletes recovering from injury.

"Seeing motion lab results and seeing the symmetry again in their joints helps their confidence levels,” said Dr. Menzer. "Having that confidence is another key aspect to a safe return to sports and a reduced chance at reinjury.''

If you would like to communicate with Dr. Heather Menzer about ACL reconstruction, please email her at