Our Preferred Technique for Bone–Patellar Tendon–Bone Allograft Preparation

Abstract

Anterior cruciate ligament (ACL) reconstruction is an increasingly common procedure as orthopaedic patients seek to remain active longer in life, resulting in more ligamentous knee injuries. Graft selection is at the forefront of decision making in knee reconstruction, with advantages and disadvantages to various grafts, including allograft to autograft. Although the gold standard for the ACL reconstruction of elite athletes and highly active patients has traditionally been bone–patellar tendon–bone autograft (BTB), this graft is not without its disadvantages, such as increased operative time, increased postoperative pain, potential for anterior knee pain, larger incision, violation of the extensor mechanism, and potentially kneeling pain. Soft tissue autografts (hamstring, quadriceps) offer a good alternative; however, they may be associated with higher rerupture rates, as well as associated donor site morbidity. Additionally, soft tissue allografts have a higher graft rupture rate. For this reason, it is the senior author’s preference to perform allograft ACL reconstruction with BTB allograft in appropriately selected patients. We describe our technique for an efficient and reproducible BTB allograft preparation.

ACL Reconstruction With Quadriceps Soft Tissue Autograft Versus Bone-Patellar Tendon-Bone Autograft in Cutting and Pivoting Athletes: Outcomes at Minimum 2-Year Follow-up

“…Many consider BPTB autograft to be this standard for such athletes. 4 However, BPTB autografts have notable drawbacks, including extensor weakness, 24 anterior knee pain, difficulty kneeling, possible patellar fracture, patellar tendon rupture, and patellofemoral osteoarthritis. 7 , 20 In addition, BPTB autografts should be used with caution in skeletally immature patients due to potential physeal injury.…”

Morphometry of the patellar tendon using a simple tracing method: a gold standard for anterior cruciate ligament reconstruction

“…The PT autograft is considered the gold standard for ACL reconstruction [18][19][20] due to its high tensile strength and possibility of re-vascularization by the inferior lateral or inferior medial genicular artery as well as Original Article https://doi.org/10.5115/acb. 22.169 pISSN 2093-3665 eISSN 2093-3673 being able to provide a good bone integration where bone parts are harvested with the tendon as a graft [2,21,22]. The PT serves as an anchor for the quadriceps tendon after blending with the periosteum of the patella.…”