Anterior Cruciate Ligament (ACL) Tears: Technique for Bone-Tendon-Bone Graft Harvest

Anterior Cruciate Ligament (ACL) Tears: Technique for Bone-Tendon-Bone Graft Harvest

This video is a cadaveric demonstration of a bone-tendon-bone graft harvesting used in ACL reconstruction. The bone-tendon-bone or BTB graft contains a portion of tendon in the middle with a piece of bone at each end. These bone pieces help the graft fuse within the tunnels that are drilled into the thigh bone and shin bone during ACL reconstruction.

Here, we have a right knee. The surgeon begins by marking where the incision will be made along the front of the knee. A scalpel and scissors are used to cut through the skin and soft tissue between the kneecap and top of the shin bone. This exposes the tendon that connects the kneecap to the shin bone, called the patellar tendon. The surgeon marks out a portion in the middle and cuts through the tendon.

Next, the surgeon uses a saw to cut out a section of bone from the bottom of the kneecap. An instrument similar to a small chisel, called an osteotome, is then used to remove the bone. The surgeon next moves below the tendon. The surgeon uses a scalpel and saw to cut out a section of bone from the top of the shinbone and then removes the bone.

The entire graft can now be cleanly removed from the knee containing the patellar tendon in the middle, with pieces of bone connected at each end. The surgeon finishes the procedure by shaping the pieces of bone, so they are the same size and shape of the tunnels that will be drilled in the thigh bone and shin bone during the ACL reconstruction.