Primary bone grafting following graft procurement for anterior cruciate ligament insufficiency

A technical recommendation of primarily bone grafting the patellar tendon graft site created following harvesting the central third of the free bone-tendon-bone patellar tendon graft for anterior cruciate ligament (ACL) insufficiency is presented. Harvesting a patellar bone-tendon-bone graft produces a stress riser that increases the potential risk of a patellar fracture. Primary bone grafting of the patellar region is recommended as a simple and safe solution, especially if a graft wider than 10-12 mm or deeper than 6 mm is taken. We feel that this will reduce even further the small likelihood of late patellar fracture. Using these principles, we have not had any late patellar fractures in over 135 consecutive ACL reconstructions since July, 1986.