Case: A 20-year-old man sustained a comminuted bone-patellar tendon-bone donor-site fracture 17 days after a contralateral anterior cruciate ligament revision reconstruction. Successful fixation was achieved by using a tricortical iliac crest allograft bone plug with mesh plate osteosynthesis. At 6 months of follow-up, the patient had full range of motion without pain. Conclusion:Patellar fractures after bone-patellar tendon-bone harvest may be treated successfully with mesh plate osteosynthesis and a tricortical iliac crest allograft bone plug. This unique fixation option addresses bone loss and restores the extensor mechanism while avoiding autograft donor site morbidity.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C57).