The following is a surgical demonstration for preparation of a quadriceps tendon autograft, specifically for an all-in-side technique for suspensory fixation both on the femoral and tibial side. This proprietary suspensory fixation device actually has a two-centimeter length of fiber tag which is attached to the base of the suspensory loop. The other end of the fiber tag is attached to a special needle to allow suturing of the fiber tag to the tendon to create a rip stop for optimal stability. As you see here, the first step is a special clamp which goes through the base of the fiber tag in the card. The other end of the clamp goes through the tendon itself. The fiber tag is two centimeters in length. The first pass with the needle is at the upper border of the fiber tag just through the tendon to anchor the suture here. Then you drop the clamp and card through to create a loop for a chevron, now passing through the fiber tag itself and the tendon for a chevron. And we're going to work from proximal to distal for the rip stop. There's the first passage. Again, drop the clamp and card through the loop. The second chevron is closer to the card, passing the needle both through the fiber tag and the tendon to create this rip stop. Once this second chevron suture has been passed, the next step is to flip the card over and there's a small hole and you're going to pass the needle through that hole to bring the needle on the other side. The same thing will be done now passing two chevrons working distal to proximal. First pass is through the base of the fiber tag and the tendon. Again, dropping the clamp and card through the second chevron working distal to proximal. Again, through fiber tag and tendon both for this pass. And the next step is just to pass the suture through the tendon itself at the upper border of the fiber tag at that two centimeter point to anchor it. Now, once that suture has been passed and tightened, cut one end of the suture that does not have the needle attached and we're going to create a circumferential wraparound type secure knot here to complete fixation on this femoral end of the graft. So you tie a nice secure knot here. Once that is done, cut the free end just above the knot and the swedge needle is used to bury the knot in the tendon. So that completes the application of the femoral side of the suspension fixation device. Now we remove the clamp. The other end of the tendon was held with a suture to the prep station. We secure the clamp to the upper end of the prep station on the femoral side that already has been done. Take out the suture on the tibial side that needs to be prepared. So we take our special clamp which is passed through the base of the fiber tag at the card and the other end of the clamp through the tendon itself. As before, at the upper border of the fiber tag, the two-centimeter point, just pass the needle through the tendon to secure the suture here. Then we'll create the two chevron passes, dropping the clamp and card through. This is through the fiber tag as you see here working proximal to distal. This is the first chevron for the rip stop. Once that is secure, drop the clamp and card through the loop. Second chevron through the fiber tag and tendon working toward the card. There's our second pass. This will give us excellent fixation for the suspension devices to the tendon itself. Flip the card over, pass through the small hole. As before, just bringing the needle to the other side. Now we're working distal to proximal. First pass through fiber tag and tendon both for our first chevron on this side. Once that's tightened down, make our second pass through the fiber tag more proximally and tendon both here with this pass. And the third pass is just through the tendon itself at that upper border of the fiber tag just to secure the suture here so we can tie our knot. So as was done in the femoral side, cut one end below the needle, wrap around the suture, and tie a secure knot here to complete fixation for the tibial end of the suspension fixation device. So we tie our secure knot here, then cut the free end, leaving the swedged end with the needle still attached to bury the knot. So this completes fixation on the tibial side. Once we cut that suture after burying the knot, it's the last step is just to unwind from the cards. So you have your tibial end on the right, does not have a button attached. The button will be attached once the graft is passed through the tibia for fixation there. The femoral side here on the left already has the button attached, but you have excellent fixation now of the tendon with the suspensory fixation devices on both the femoral and tibial side with the ripstop technique. www.ottobock.com

quadriceps tendon autograft

all-in-side technique

suspensory fixation

chevron sutures

femoral and tibial sides