Techniques

Published in paper:

Fink C, Herbort M, Abermann E, Hoser C. Minimally invasive harvest of a quadriceps tendon graft with or without a bone block. Arthroscopy techniques. 2014;3(4):e509-13.

Since QT autograft has mostly been reserved for revision surgeries in the past, due to a technically challenging open harvesting procedure with a high learning curve and less cosmetically attractive scaring, Fink et al. had a goal to develop a minimally invasive, less anatomically disruptive and at the same time easily reproducible technique for QT harvest.

Technique Steps

Fig 1. Skin incisions. A 2.5 to 3 cm transverse skin incision (solid line) may be recommended for the best cosmetic result. Alternatively, a 2.5 to 3 cm longitudinal incision (dotted line) may be used.
Fig 2. A double knife is introduced starting slightly lateral to the middle of the superior patellar border11,18 and pushed up (white arrow) to the desired tendon length. There are centimeter markings on the instrument.
Fig 3. Graft thickness is determined using a 5 mm tendon separator. The tendon separator is then pushed proximally (white arrow) to the previously determined length. There are centimeter markings on the instrument.
Fig 4. The tendon strip is cut subcutaneously by a special tendon cutter at the determined length (white arrow).
Fig 5. The bone block is harvested using an oscillating saw. (A) First, the longitudinal and transverse cuts are made. (B) The last cut determines the thickness of the bone block and is made from proximal to distal. (C) Finally, the block is easily elevated.
Fig 6. (A) After retrieving the QT graft, it is pulled distally, and (B) a strip of periosteum in the appropriate width is detached about 2 cm in length.
Graft preparation!

Fig 7. Graft preparation without bone block. (A) Final graft with strip of periosteum measuring approximately 2 cm. (B) The periosteum is folded in the middle and (C) fixed in the clamp of a preparation board. (D) Web-stitch sutures are placed on each side of the graft using nonresorbable No. 2 suture material. (E, F) This results in a smooth, round end of the graft, which allows easy graft passage.
Karl Storz Minimally Invasive Quadriceps tendon harvesting set

Components:

• Tendon Knife
• Tendon separator
• Handle
• Tendon cutter

The harvesting system offers special knife sizes which, depending on the indication, can be selected for cruciate ligament or MPFL reconstruction

Publications

Video