BPTB Allograft

Graft Preparation

 

BPTB Allograft Initial

 

Defrost

- in 2 litres normal saline

- can add vancomycin powder

 

Choose which part of graft to use

- usually central third

- can take either side

- try to leave sufficient graft in case of disasters

- i.e. dropping or rupturing graft

 

BPTB Allograft Tendon Cut

 

Cut tendon with knife

- 10 mm thick in women

- 12 mm thick in men or revisions

- adjust to patient's size and needs

 

Cut soft tissue on patella / tibial tuberosity ends

- usually narrow graft so becomes 10 mm wide

- can make 12 mm wide in revision setting

 

Length of bone femoral side

- usually 20 mm on femoral side

- this is usually from the patella

- cut with saw on each side

- turn and cut so is 10 mm thick

- ensure this end fits nicely through 10 mm / 12 mm tube

- this will be the passing end

 

BPTB Allograft Saw 1BPTB Allograft Saw 2

 

Length of bone on tibial side

- depends on fixation method

- risk is donor-recipient mismatch

- best to keep this side long / take from tibial end of graft

 

Graft mismatch

- if donor tendon too long for recipient knee, all bony graft will be outside tunnel

- if too short, a lot of the bony graft will be pulled into tunnel

- so keep bone graft long

- at least 30 mm

- can always shorten the tibial graft end if needed

 

BPTB Allograft Final 1BPTB Allograft Final 2

 

Drill holes x 2 in each bony block

- pass 1 ethibonds x 2 with suture passer

- tension

 

Tunnels

 

Standard tunnels via preferred technique

- tunnel diameter line to line

- femoral tunnel 5 mm deeper than bone bloc

 

Tibial fixation

- prepare a tibial groove

- using saw

- in tibia from drill hole inferiorly

- 1 cm wide, 3 cm long

- so that can secure excess tibial bone block down into this groove

 

Graft fixation

 

Pass graft

 

Fix femoral graft

- 7 x 25 screw for 10 mm graft

- same for 12 mm graft

 

Tibial graft

- either pass screw 9 x 25 mm (10 mm tunnel)

- can fix into tunnel with staples (small or medium richards)

 

ACL BPTB Allograft LateralACL BPTB Allograft AP