Table 1.

Key Steps for Bone–Patellar Tendon–Bone Autograft Harvest for ACLR

Identify anatomic landmarks

Tibial tubercle

Patellar borders

Vertically oriented skin incision—approximately 5 cm

Visualization of both medial and lateral borders of the patellar tendon

Incise and preserve the paratenon for complete visualization of the patellar tendon

Measure and mark the central one-third of the patellar tendon

Longitudinally incise the tendon from proximal to distal after collagen orientation

Harvest tibial plug—10 mm × 25 mm

Harvest patella bone plug—10 mm × 20-25 mm

Separate autograft from the underlying patellar fat pad

Accurately size the bone plug according to the surgeon's preference

Write down bone plug measurements

Drill 2 holes in the tibia bone plug and 1 hole in the femoral bone plug—using the K wire

Passing a No. 5 suture through each hole

Mark the bone-tendon junction on both bone plugs for proper orientation during graft passaging and fixation

Bone grafting—focus on the patella first

Closure of the paratenon using a No. 1 absorbable suture

Closure of subcutaneous and skin layers in a standard fashion

ACLR, anterior cruciate ligament reconstruction.