Surgical anatomy and technical pearls for quadriceps, distal hamstring, and iliotibial band management in knee reconstruction

<h2>Abstract</h2> The quadriceps, distal hamstrings, and iliotibial band (ITB) complexes are critical for knee function and stability. Understanding their detailed anatomy is essential for safe and effective surgical techniques in anterior cruciate ligament (ACL) reconstruction, patellar instability correction, and related procedures. The quadriceps tendon's trilaminar structure and medialized insertion must be appreciated during graft harvest and quadricepsplasty to optimize strength while minimizing donor-site morbidity. On the medial knee, the semitendinosus and gracilis tendons at the pes anserinus require precise identification to enable efficient harvest for ACL and medial patellofemoral ligament (MPFL) reconstruction with minimal neurovascular injury. On the lateral knee, the ITB and its Kaplan fibers serve as secondary ACL stabilizers, and understanding their anatomic relationships guides proper graft orientation during lateral extra-articular tenodesis (LET). This review provides technical pearls and anatomic considerations to support precise surgical execution, reduce complications, and preserve long-term joint health across knee soft-tissue reconstruction procedures.