Anterior Cruciate Ligament (ACL) Tears: Technique for Quadriceps Graft Harvest

Anterior Cruciate Ligament (ACL) Tears: Technique for Quadriceps Graft Harvest

This video is a cadaveric demonstration of a quadriceps graft harvesting used in ACL reconstruction. The quadriceps tendon attaches the four quadriceps muscles located at the front of the thigh to the kneecap. Only the central portion of the quadriceps tendon will be removed, so that the quadriceps muscles will still be able to function.

Here we have a left knee. The surgeon begins by marking where the incision will be made above the kneecap, and then uses a scalpel to cut through the skin and soft tissue. A surgical instrument is then inserted under the skin to help separate the tendon from the surrounding soft tissue.

Next, a camera is used to view the quadriceps tendon and muscles under the skin. The surgeon will point the light of the camera up through the skin to mark the end of the tendon. The surgeon then marks the end of a circular instrument to mark the width of the graft. A scalpel is used to cut the lower end of the tendon off of the kneecap.

The surgeon then uses a clamp to hold on to the tendon to pass a suture through the bottom end of the graft. The suture is used to pass the end of the graft into a specialized instrument called a quadriceps harvester. While an assistant stabilizes the knee, the surgeon inserts the end of the quadriceps tendon into the quadriceps harvester, gently twisting and moving upward.

Once the desired length of the graft is achieved, the surgeon pulls the quadriceps harvester out slowly and then inserts the cutter into the harvester to cut the upper portion of the quadriceps tendon off from the muscle. The surgeon will then use surgical instruments to close the remaining quadriceps tendon together with sutures. The tendon graft will be prepared with sutures to be used as the new ACL.