Quadriceps Tendon Cylinder‐Shaped Anterior Cruciate Ligament Reconstruction With Suspensory Fixation

Figures

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  Fig 1. A 10 × 10–cm gauze is used to remove residual fat within the incision.

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  Fig 2. The QuadPro tendon harvester is used to make a mark and is pushed to the distal aspect of the tendon just adjacent to the patella to approximate the width of the graft.

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  Fig 3. The width between incisions should be based on the desired graft diameter. Longitudinal incisions are made distally toward the patella until the bone is in contact.

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  Fig 4. By use of a FiberLoop, the tendon is sutured 1 cm from the end of the graft. This suture functions as a tagging suture and is used to maintain tension on the graft during tendon harvesting.

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  Fig 5. Sutures in the tendon are pulled through the cannula of the QuadPro tendon harvester. The tendon is pulled into the tip of the harvester, ensuring that the tagging suture is not cut by the harvester’s tip. Steady, gentle tension is kept on the suture, and the QuadPro harvester is rotated (blue arrows) while advancing up the tendon, directing the harvester toward the proximal mark on the skin.

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  Fig 6. Once the desired graft length has been removed, the QuadPro tendon harvester is withdrawn from the incision, and the graft is retrieved through the graft amputation window by grasping the tagging sutures.

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  Fig 7. The QuadPro tendon harvester is placed back into the incision. When the appropriate graft length is reached, the push rod is inserted into the harvester. Tension is maintained on the tagging suture while the position of the harvester is maintained.

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  Fig 8. The push rod is advanced forward to amputate the graft. Deploying the push rod into the handle via a syringe-type motion allows easy amputation.

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  Fig 9. A quadriceps tendon cylinder-shaped graft is obtained.

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  Fig 10. FiberTag TightRope proximal graft preparation. A TightRope suture card (yellow arrow) is loaded into the card-holding slot of the GraftClamp instrument (orange arrow). The FiberTag suture (black rectangle) is 20 mm (white dots), marking the starting point for the whipstitch. The FiberTag suture turns into the FiberLoop suture (red oval).

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  Fig 11. FiberTag TightRope distal graft preparation consists of the same steps as FiberTag TightRope proximal graft preparation. The black rectangle indicates the FiberTag suture; yellow arrow, TightRope suture card; red rectangle, FiberTag suture for distal graft fixation; and green arrow, FiberLoop suture free ends.

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  Fig 12. Final preparation of graft. At the distal/tibial end of the graft (solid red arrow), the white looped self-tying sliding sutures (dotted red arrow) are used to block the TightRope ABS button (red circle) on the tibial cortex. The white sutures are secured to the button through opposing slots (red dash arrow) . The blue suture is used for further safety, and the free ends are passed through small holes (red dash arrow). At the proximal/femoral end of the graft (yellow arrow), the sutures mark the length of the condyle (yellow rectangle), and the tendon is marked according to the measurement of the femoral half tunnel (yellow circle).