Bone-Patellar Tendon-Bone (BTB or BPTB) Harvest for ACL Reconstruction

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This ACL graft involves a bone plug from the tibial tubercle, the central 1/3 of the patellar tendon and a bone plug form the patella.

1️⃣ Patellar Tendon.
2️⃣ Bone plug from tibial tubercle.
3️⃣ We take a small piece of extra bone from the tibial tubercle plug and use it as bone graft in the recipient patellar bone plug site.
4️⃣ Middle 1/3 of the patellar tendon removed.
5️⃣ Closure of the patellar tendon with the knee at 90 degrees of flexion.
6️⃣ Closure of the peritenon with the knee at 90 degrees of flexion.
7️⃣ BTB autograft.
8️⃣ Final ACL reconstruction with BTB autograft.

ACL Graft: Bone-Patellar Tendon-Bone or "BTB"

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ACL Graft: Bone-Patellar Tendon-Bone or "BTB"

For me, the BTB is the “Luxury Sports Car of Grafts” – it’s built for speed and power, it’s sexy, it wins races, but it comes at a potential cost, and it may be more than some people need. I prefer using the BTB graft for my patients who are in the athletic population, unless there are specific patient variables that make me think it is not the best choice or contraindicated. 

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