Quadriceps tendon harvest for anterior cruciate ligament reconstruction

The quadriceps tendon provides a robust, safe, and easy-to-harvest graft for anterior cruciate ligament reconstruction. It may be used as an all-soft-tissue free tendon graft with predictable success and less pain than other autograft alternatives.

The quadriceps tendon is twice as thick as the patellar tendon, and therefore the surgeon may harvest a 10-mm-wide graft by carefully defining this desired thickness at the time of tendon graft harvest.

Obtain both rectus and intermedius components of the quadriceps tendon to ensure adequate graft bulk.

Use of a traction suture at the distal end of the graft will help control the graft during harvest.

Careful dissection of the undersurface of the graft can avoid violation of the joint capsule.

Keep the knee flexed for graft harvest to ensure adequate tension in the quadriceps tendon. This facilitates harvest of the graft.

Remember that the quadriceps tendon is oriented in an oblique trajectory from the distal to proximal end, aimed laterally. Care should be taken when harvesting to stay within the substance of the tendon and not the muscle.