Anterior Cruciate Ligament (ACL) Tears: Bone-Tendon-Bone Graft Preparation

Anterior Cruciate Ligament (ACL) Tears: Bone-Tendon-Bone Graft Preparation

This video is a demonstration of a bone-tendon-bone graft preparation 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.

Seen here, the surgeon has already placed regular sutures through drilled holes in one of the bone pieces at the end of the graft. This end will be pulled through the tibia, or shin bone, during the surgery. A small hole has been drilled in the other piece of bone, which will be placed in the tunnel in the thigh bone.

The surgeon begins by using a needle to pass sutures from an adjustable suture device that is contained on this card, through the hole in the bone at the top of the graft. The needle is then cut off. The surgeon then passes the free end of a second suture through the loop of sutures threaded through the graft. This suture is then passed through a wire loop attached to the card.

The surgeon pulls the tab on the card to pass the wire and suture through the card. This creates the mechanism for the surgeon to tension the graft toward the end of the surgery. The surgeon then flips the card over and pinches the tabs to release all the sutures. The card is then opened to reveal a small metal button, which is where the sutures from the graft have been threaded through.

The surgeon pulls the button and all of the sutures out of the card, and will make sure that the sutures can slide easily through the bone at the top of the graft. These sutures will be used to tighten and secure the metal button in place during the ACL reconstruction.