*4.10.2 Step 2: Graft Harvesting and Preparation*

A longitudinal incision is made over the pes anserinus, and dissection carried out down to the level of the sartorial fascia. The sartorial fascia is identified and incised proximal to and in line with the gracilis tendon. The gracilis tendon is bluntly dissected off of the sartorial fascia, and brought out of the wound using a hemostat (**Figure 7A** and **B**).

The open hamstring stripping device (Stryker Orthopedics, Mahwah, NJ) is used to harvest a gracilis tendon autograft, maintaining the distal attachment during the harvesting process. Once harvested, the gracilis tendon is detached sharply at its insertion taking care to avoid damage to the semitendinosus tendon. The muscle belly is removed from the gracilis tendon using a periosteal elevator. A whip stitch is applied to the distal end of the gracilis tendon using a No. 2 orthocord suture (DePuy Mitek, Warsaw, IN). The gracilis tendon graft is placed in a moist lap sponge while attention is now turned to the placement of suture anchors in the medial border of the patella.
