Table 2.

Pearls and Pitfalls Associated With Bone–Patellar Tendon–Bone Autograft Harvest for ACLR

Pearls	• Perform examination under anesthesia and confirm diagnosis of ACL tear before harvesting the patellar tendon
	• Leave at least 10 mm of native patellar tendon medially
	• Score the cortex of the tibial and patellar bone plugs before cutting into the bone
	• For the horizontal (cross) cut for both the tibial and patellar plug, aim the saw 45° obliquely toward either of the longitudinal cuts, to avoid cutting beyond the longitudinal cuts, thus avoiding the creation of a potential stress riser in the tibial bone
	• Anterior knee pain after BPTB harvest may be reduced by bone grafting the patellar and tibial bone plug harvest sites
Pitfalls	• Making skin incision directly in the midline will make it difficult to use that incision for tibial tunnel drilling—ensure that the incision is slightly medial to avoid this problem
	• Take care not to narrow or widen the second incision relative to the initial incision when harvesting the middle third of the patellar tendon
	• Avoid harvesting plugs that are too large (donor site morbidity and more difficult graft preparation) or too small (inadequate graft)
	• Avoid mallet use on the patella (or minimize) to avoid iatrogenic patellar fracture

ACL, anterior cruciate ligament; ACLR, anterior cruciate ligament reconstruction; BPTB, bone–patellar tendon–bone.