Applied Anatomy of the Quadriceps Tendon Related to the Technique of Harvesting the Quadriceps Tendon Graft

Introduction: The quadriceps tendon (QT) is a common autologous graft for anterior cruciate ligament reconstruction. However, the best way to harvest it is still undefined. This study aims to determine the QT’s anatomical structures as a graft for anterior cruciate ligament reconstruction and the ideal harvest site. Methods: Thirty fresh frozen knees from 15 cadavers were dissected, and the QT was analyzed. The length, depth, and width of the QT were measured in a standardized manner for each cadaver. Results: The QT superficial morphology showed 2 distinct peaks, with the maximum length correlating with the real lateral peak. The full length of the tendon was located at 64.3%±5.4% of the width from the medial border of the insertion. The maximum length of the QT was 79.4±4.5 mm. The mean width at its insertion onto the patella was 36.0±4.3 mm. The thickness at its maximum length on patella insertion was 7.2±0.4 mm. The mean diameter of the QT graft was 8.5±0.5 mm, with a mean cross-sectional area of 64.7±4.1 mm2. Conclusion: QT graft harvest should begin by locating the apex (maximum length) of the tendon (64.3% of the distance from the patella’s medial edge). The surgeon should then harvest a 10 mm wide graft medially to the maximum length, harvesting 70 mm long and full-thickness tendon.