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C. FINK, M. HERBORT, P. GFÖLLER, C. HOSER
122
is outlined with a scalpel, cutting down to the
patella. Next an oscillating saw with a narrow
blade (0.5-0.7 cm) and a chisel are used to
harvest a bone plug 1.5 cm long with a width
and thickness conforming to graft geometry. To
avoid patellar fractures, it is advisable (as in the
conventional harvesting technique) to finish by
sawing parallel to the anterior patellar surface
in a proximal-to-distal direction with the
narrow saw blade (fig. 2). At that point the
bone plug is easily mobilized with a chisel. The
free end of the tendon is whipstitched with two
nonabsorbable N° 2 lead sutures. The bone
plug is tailored to form a rectangle of the
desired size. Rounding the proximal corners of
the bone plug will facilitate later graft passage
into the joint. Two 1.5 mm holes are drilled in
the bone plug, which is then tied to a
FlippTack® fixation button (Karl Storz,
Germany) with a nonabsorbable suture (e.g.
Fibre Wire®, Arthrex Naples FL).
Fig. 1:
(
a
) Subcutaneous advancement of the tendon knife. The cutting edges are spaced at the desired
graft width. (
b
) Insertion and advancement of the 5 mm tendon separator. (
c
) Subcutaneous advancement
of the quadriceps tendon cutter.
Fig. 2:
Harvesting the bone plug with
the oscillating saw. The last cut is
made in a proximal-to-distal
direction, tailoring the thickness of
the bone plug to the graft thickness.
b
a
c