(Fig 2-C.02) Bone-patellar tendon-bone (BPTB) autograft -1

https://youtu.be/ucPGY9r0cv8

https://youtu.be/uDgqFi3itg0

Bone-Patellar Tendon-Bone (BPTB) Autograft

 

1️⃣ Optimal Patient

• Age: Less than 35 years old
• Engaged in high-level pivoting sports with high physical demand

2️⃣ Advantages

• Bone-to-bone healing potentially leads to more aggressive rehabilitation
• Low graft rupture rates comparable to quadruple hamstring tendon (QT) grafts
• High return to sport rates

3️⃣ Disadvantages

• Highest rate of donor site morbidity and anterior knee pain
• Higher rates of osteoarthritis (OA) progression
• Risk of patellar fracture or patella tendon rupture
• Not suitable for skeletally immature patients
• Possible higher risk of contralateral ACL rupture
• Decreased extensor strength

4️⃣ Procedure

• Harvested from the central third of the patellar tendon with bone grafts from the inferior pole of the patella and tibial tuberosity
• Bone grafts initially anchored within the tunnels using interference screws
• Achieves deeper fixation through bone-to-bone healing, known to occur as early as 16 weeks following surgery

 

✅ Screw and Washer

• Greater length required to ensure sufficient graft length along the interference screw
• Adequate length necessary for proper fixation and stability
• Additional length required when using a spiked ligament screw washer on the tibial cortex
• Graft must extend out of the tibial tunnel to accommodate the washer

 

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