BTB

Illustration of the front of the knee joint to show where the B-T-B graft is harvested from.

What is a B-T-B graft used for?

A bone-patellar tendon-bone (B-T-B) graft is generally used to replace a torn anterior cruciate ligament. The bony ends of the preparation are useful in allowing fixation devices to firmly attach the graft into the new position.

• Quote from peer-reviewed paper:

  "...The central-third of the native patellar tendon is a reliable graft and is the preferred option for competitive athletes given its excellent track record with high return-to-play rates and low failure rates...."

  Citation: Frank RM, Higgins J, Bernardoni E, Cvetanovich G, Bush-Joseph CA, Verma NN, Bach BR Jr. Anterior Cruciate Ligament Reconstruction Basics: Bone-Patellar Tendon-Bone Autograft Harvest. Arthrosc Tech. 2017 Jul 31;6(4):e1189-e1194. doi: 10.1016/j.eats.2017.04.006. PMID: 29354416; PMCID: PMC5621981.

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Advantages and disadvantages of B-T-B graft

The B-T-B graft is strong and the bony ends allow good fixation and consolidation when it replaces the anterior cruciate ligament.

However, there may be considerable discomfort at the harvest site and exceptionally the patellar tendon may rupture.

• Quote from peer-reviewed paper:

  B-T-B ".... is better than free [semitendinosis-gracilis] and [semitendinosis-gracilis with preserved tibial insertion] grafts in terms of knee stability....[but] compared for patient reported outcome, return to sports activity, osteoarthritic changes and graft failure there is no significant difference among the three types of grafts..."

  Citation: Soni A, Gupta RK, Raghav M, Masih GD, Bansal P. Comparison of Bone-Patellar Tendon-Bone Graft, Semitendinosus-Gracilis Graft and Semitendinosus-Gracilis with Preserved Tibial Insertion Graft in Anterior Cruciate Ligament Reconstruction in Sports Persons. Malays Orthop J. 2021 Jul;15(2):12-17. doi: 10.5704/MOJ.2107.003. PMID: 34429817; PMCID: PMC8381676.

• Quote from peer-reviewed paper:

  ".... Disadvantages to using this graft include donor site morbidity and associated postoperative anterior knee pain, the risk of patellar fracture or patellar tendon tear, and the potential for graft-construct mismatch...."

  Citation: Frank RM, Higgins J, Bernardoni E, Cvetanovich G, Bush-Joseph CA, Verma NN, Bach BR Jr. Anterior Cruciate Ligament Reconstruction Basics: Bone-Patellar Tendon-Bone Autograft Harvest. Arthrosc Tech. 2017 Jul 31;6(4):e1189-e1194. doi: 10.1016/j.eats.2017.04.006. PMID: 29354416; PMCID: PMC5621981.

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Healing after B-T-B graft harvest

The surgeon may choose to bone graft the patellar and tibial harvest sites pre-emptively to speed up bone healing and reduce post-operative anterior knee pain.

• Quote from peer-reviewed paper:

  "....loss or disturbance of anterior sensitivity caused by intraoperative injury to the infrapatellar nerve(s) in conjunction with patellar tendon harvest is correlated with donor-site discomfort and an inability to kneel and knee-walk. The patellar tendon at the donor site has significant clinical, radiographic, and histologic abnormalities 2 years after harvest of its central third....."

  Citation: Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy. 2001 Nov-Dec;17(9):971-80. doi: 10.1053/jars.2001.28979. PMID: 11694930.

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Forum discussions

• Patellar tendon has not filled years after recon

  Patient discussion about continuing defect in patellar tndon after harvest.

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