Backfilling Patellar and Tibial Harvest Sites Using Autologous Bone Reamings and Anterior Cruciate Ligament Remnant Tissue During Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction.

The bone-patellar tendon-bone autograft remains a common and often first-choice option for anterior cruciate ligament reconstruction. Nevertheless, a subset of patients suffer from chronic anterior knee pain at the site of graft harvest. Although prior literature has indicated that backfilling of the patellar and tibial defects decreases the risk of donor site pain, sourcing and harvesting of the graft material, as well as the management of the paratenon and underlying tendon defect, remains variable. This technical note and associated video describe our preferred technique for the backfilling of these defects using both bone and soft-tissue grafts, with paratenon preservation to improve containment and potentially incorporation of grafted material.