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Patellar Tendon Graft Preparation

- Debride Bone Edges:

     

- Drill and Pass Sutures:
    - note that many surgeons will prefer to make bone plug drill holes before the plug is harvest w/ a saw;
    - use a 2 mm drill to make three drill holes into the graft for the tibial tunnel and 2 drill holes into the graft for the femoral tunnel;
          - these drill holes should be staggered at 45 degree angles thru the cortical surface, in order to lessen the chance that the sutures will be 
                cut by the threads of the interference screws;
          - drill holes should be placed at the outside edges of the plug, inorder to facilitate passage of the plug thru the femoral tunnel;
    - if the one incision (transtibial technique) is used, then #5 Ethibond sutures are passed thru the tibial bone plug and #2 Ethibond sutures 
          are passed thru the femoral bone plug (a smaller suture is used, because this suture must pass thru the Nitinol guide wire;
    - a saftey stitch may be placed thru the bone-tendon interface of each plug, which helps ensure that the interference screw will not cut 
          through all of the bone plug sutures;

           

- Size the Grafts:
    - additional debridement may be required;
    - sharp edges of the bone plug may be gently crushed with pliers, inorder to shape it into a circle;

     

- Mark the Graft:
    - outlining the bone-tendon interface facilitates positioning of the grafts in the femoral and tibial tunnels;
    - mark the cortical surface of the distal end of the tibial graft (this will facilitate identifying the rotational position of the graft once in the
          tibial tunnel);
         

- Allograft: (indications controversial)



Reconstitution of the patellar tendon donor site after graft harvest.

Correlation of remaining patellar tendon width with quadriceps strength after autogenous bone-patellar tendon-bone anterior cruciate ligament reconstruction.

Isolated autogenous bone-patellar tendon-bone graft site morbidity.