Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Autograft to Avoid Harvest-Site Morbidity in Knee Arthroscopy Eitaku Koh,

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Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Autograft to Avoid Harvest-Site Morbidity in Knee Arthroscopy Eitaku Koh, M.D., Kenichi Oe, M.D., Seisuke Takemura, M.D., Hirokazu Iida, M.D. Arthroscopy Techniques Volume 4, Issue 2, Pages e179-e184 (April 2015) DOI: 10.1016/j.eats.2015.01.002 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 Surgical instruments (Ario Medical): (A) guide plate, (B) scalpel blade, (C) scalpel holder, (D) bone fragment harvester, (E) drill holder, and (F) trephine drill. Arthroscopy Techniques 2015 4, e179-e184DOI: (10.1016/j.eats.2015.01.002) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 Surgical procedure involving left knee, flexed at 90° (the insets in some panels are lateral radiographs, taken under fluoroscopic guidance). (A) Skin and paratenon incision. The paratenon is exposed and incised in the transverse direction. (B) Guide plate fixation. The tibial side of the guidewire is fixed using a K-wire. (C) Cutting of patellar tendon. The patellar tendon is incised between the paratenon and patellar tendon by pushing the tendon cutter (scalpel holder and blade) along the guide plate. (D) Detachment of tibial bone fragment. A soft wire is inserted through the tibial bone fragment and is doubled up. (E) Detachment of tissue attached to patellar tendon. The detached tibial bone fragment and patellar tendon are pushed through the bone fragment harvester. (F) Preparation to detach patellar bone fragment. A large beak of the drill holder is hooked on the already fixed K-wire above the patella. (G) Cutting of patellar bone. Osteotomy of the patellar bone is performed using the trephine drill after hooking the large beak of the drill holder. (H) Detachment of patellar bone fragment. The bone fragment harvester is advanced from the bottom to the center of the patella. (I) Bone–patellar tendon–bone (BPTB) graft release. The BPTB graft is completely harvested. Arthroscopy Techniques 2015 4, e179-e184DOI: (10.1016/j.eats.2015.01.002) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Bone–patellar tendon–bone (BPTB) autograft. (B) Arthroscopic view from anterolateral portal of left knee. The BPTB graft tension is confirmed with a probe. Arthroscopy Techniques 2015 4, e179-e184DOI: (10.1016/j.eats.2015.01.002) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions