Fig 2.

QT graft harvesting. (A) The scar of a QT ACL 3 months postoperatively and is an example for the incision of harvesting the QT. (B).Left knee intraoperatively in 90° of flexion with subcutaneous dissection already done and a Langenbeck retractor inserted to expose the surface of the QT. After exposure of the tendon, a double knife (Medacta) with the adequate width (small, medium, large) is inserted, shown in (C), starting slightly lateral to the midpoint of the superior patellar border, to a minimum depth of 70 mm (judged using calibrations on the instrument handle) and extending 20 mm distally over the patella. Graft thickness is determined with a 4.5-mm tendon separator (Medacta), which undercuts the QT as shown in (D). The separator is inserted to the same length as the parallel-bladed double knife (min. 70 mm) as determined by calibrations on the instrument handle. In (E), proximal tendon division and retrieval are shown in a schematic knee. Both are accomplished using the tendon cutter/grasper (Medacta). A firm compression of the handle divides the tendon proximally subcutaneously. Keeping the tendon cutter closed around the tendon and retrieving it takes the proximal tendon end with it. (ACL, anterior cruciate ligament; QT, quadriceps tendon.)