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Chap. 15 Video 9: Tips for Harvesting BTB Autograft

February 05, 2016

Contributors: K Donald Shelbourne, MD

This video demonstrates tips for the contralateral harvesting of a bone-to-bone autograft for ACL reconstruction. The patella and patellar tendon are marked, and an incision is made along the medial border of this tendon. An incision is made into the paratenon to expose the tendon, and flaps are maintained for closure. A 10 mm graft is taken from the central third of the tendon from proximal to distal. Centimeter deep bone plugs are cut first medially, then laterally for each end. Holes are drilled in bone plug ends and sutures passed, and a sizing guide is used to ensure the graft passes through an 11mm hole. The soft tissues of the graft are injected with Marcaine and epinephrine. Bone graft is packed into the patellar and tibial defects, and the paratenon is closed over both. Rehab is discussed and includes high repetition low weight exercises; then flexion and extension are checked, a subcutaneous drain is placed, and closure is performed.

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