Fig 13.

Graft insertion and final graft appearance. To insert the graft, a shuttle loop is needed: It is first set using a Beath pin via the anteromedial portal seen in (A). The loop is then pulled into the joint and grasped via the tibial tunnel with a hook and pulled extra-articularly distally (B). Using this shuttle loop, the graft is then inserted with its pulling strands, as can be seen in (G) looking on a left knee intraoperatively from anterior, in this case using a flat semiT graft. For insertion, the graft needs to be oriented with its concavity (in G looking up) looking laterally. (C-D) The final quadriceps tendon graft with its natural fiber orientation intra-articularly from a lateral standard portal view and a medial portal view respectively. (E-F) A semiT graft is shown intra-articularly from a lateral standard portal view in 90° of knee flexion (E, asterisk: anterior lateral meniscus root) and close to extension (F).