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Figure 3

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(A) Graft harvest planning: 10 cm of the quadriceps tendon is performed, taking the medial 1/3 of the quadriceps tendon and whipstitching with a non-resorbable suture. The graft is left attached to the patella distally. A thin cuff of the tendon is left attached to the VMO to facilitate later closure of the defect. (B) Graft harvest: The quadriceps tendon has 3 and sometimes 4 layers that distally fuse but can still be defined more easily proximally where they become more distinct. The graft harvest should include the full thickness of the tendon.

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