Specialized Toolkit Series: ACL Reconstruction-Quad Tendon Circular Graft Harvest

Video Transcription

The following is a surgical demonstration for a different way for a minimally invasive harvest of the carotid tendon as an autograph for ACL reconstruction.  As you see, I start with the inflexion at 90 degrees and I make a longitudinal incision in the midline, 2.5 centimeters in length.  I prefer the longitudinal incision because it makes it easier for me to close the resultant  defect in the carotid tendon, which I do routinely in all cases, but you can go with a transverse incision if you believe that is better cosmetically.  The carotid tendon is very superficial through the skin and subtense tissue as you see here. In this case, I'm going to utilize a circular harvester.  It has a diameter between 9 and 11 millimeters, which I choose based on the size of the patient. I mark that diameter on the carotid tendon and I release it sharply off the superior  pole of the patella. I like a full thickness graft, which you'll see here, but you can go partial thickness if you like.  I release it for a distance of one centimeter and I pass the stay suture through the release end of the tendon as shown here, keeping the needle attached because the needle will be  used for traction purposes on the tendon, passing through my harvester. So next step is passing this suture through the harvester of the diameter that you chose.  And then I bring the needle to approximately 60 degrees of flexion, taking tension off the carotid tendon and make sure I'm parallel to the tendon as I harvest approximately to  the appropriate depth. Usually for me, it's 65 millimeters for an all-in-side graft, but you can read the depth off the harvester and go approximately as long as you want.  Then I back up the harvester, I pass the suture off the side window, then I just push the harvester back up to the release end of the graft where I stopped, and then the tendon  is on top. Then I bring in my harvester plunger, but now I bring the knee to about 40 degrees from  full extension again to take tension off, and I just push on the plunger and out comes the graft. So I've got a nice length of the graft as you see here.  Then what I do next is bring the knee back to 90 degrees of flexion and I completely close the defect in the carotid tendon with interrupted number one vicral horizontal matrix  sutures, and then I close the skin.

Video Summary

This surgical demonstration outlines a minimally invasive method for harvesting the carotid tendon as an autograph for ACL reconstruction. The procedure begins with a 2.5 cm longitudinal incision at the midline. A circular harvester with a diameter of 9-11 mm, depending on patient size, is used to release and extract a full thickness graft from the tendon. Key steps include maintaining flexion to reduce tension, ensuring the harvester parallels the tendon, and using a needle for traction. The procedure concludes with closing the tendon defect and suturing the skin.

Asset Caption

Patrick Smith, M.D.
Columbia Orthopaedic Group
Columbia, Missouri

Keywords

minimally invasive

quadriceps tendon

ACL reconstruction

autograft

surgical technique

carotid tendon

surgical procedure

graft harvesting