Bone-Patellar Tendon-Bone (BPTB) Autograft
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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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