1. Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction 
Adrian Todor, M.D., Ph.D., Sergiu Caterev, M.D., Dan Viorel Nistor, M.D., Youssef Khallouki, M.D. 
Arthroscopy Techniques 
Volume 5, Issue 3, Pages e541-e544 (June 2016)
DOI: /j.eats
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
Landmarks for the skin incision for harvesting the free quadriceps tendon graft. The proximal pole of the patella is marked, and the skin incision is outlined (arrow). A left knee is shown, with the patient positioned supine and the knee flexed to 90°.
Arthroscopy Techniques 2016 5, e541-e544DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
The depth of the No. 10 scalpel blade measures 7 mm and can be used as a reference for the depth of the incision in the quadriceps tendon.
Arthroscopy Techniques 2016 5, e541-e544DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
A curved hemostat is placed through the medial incision in the quadriceps tendon, through the tendon at the desired depth, and out the lateral incision. This defines the thickness and width of the graft. A right knee is shown, with the patient positioned supine and the knee flexed to 90°.
Arthroscopy Techniques 2016 5, e541-e544DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
After the release of the quadriceps graft from the patellar insertion with the scalpel, the hemostat is pushed distally to complete the release. A left knee is shown, with the patient positioned supine and the knee flexed to 90°.
Arthroscopy Techniques 2016 5, e541-e544DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
By use of the whipstitched sutures placed in the distal end, the graft is manipulated and the dissection is carried out proximally with the scissors. A left knee is shown, with the patient positioned supine and the knee flexed to 90°.
Arthroscopy Techniques 2016 5, e541-e544DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

7. Fig 6
Free bone quadriceps tendon after harvest on the back table; it measures 9 cm in this case. High-strength sutures are seen whipstitched on one end.
Arthroscopy Techniques 2016 5, e541-e544DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

8. Fig 7
Knots are tied through the button loop with the high-strength sutures placed initially to secure the button to the graft. We recommend placing 4 knots through the loop in alternating fashion and then 6 knots around the loop also in alternating fashion to achieve a very secure fixation.
Arthroscopy Techniques 2016 5, e541-e544DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions