*4.10.7 Step 7: Secure Distal and Then Proximal End of the Graft to the Patella*

A free needle is used to whip stitch the graft to the appropriate suture anchor at each level. The unused end of the graft is pulled to take up the slack, bringing the

#### **Figure 11.**

*The patient is in the supine position, the left knee flexed to 45°, when the gracilis tendon autograft is passed from the femoral fixed side through the intra-articular, extrasynovial plane using a hemostat and exiting out the opening at the medial border of the patella. Once the graft is passed, with the knee held in 45° of flexion, the graft is marked where it aligns with the more distal suture anchor, and then from there the distance between the 2 suture anchors is marked off on the graft. Arrows denote the location of 2 suture anchors. Reproduced with permission from: Kurowicki et al. [130].*

#### **Figure 12.**

*The patient is supine with the knee in 45° of flexion and a free needle is used to whip stitch the graft to the appropriate suture anchor at each level. The unused end of the graft is pulled to take up the slack, bringing the graft down to the bone and suture anchor. The knots are subsequently tied, starting with the distal anchor and then the proximal anchor, and the excess graft is cut off. The blue star denotes excess graft. Reproduced with permission from: Kurowicki et al. [130].*

graft down to the bone and anchor. The knots are subsequently tied, starting with the distal anchor and then the excess graft is cut off (**Figure 12**).
