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INTRODUCTION
The quality, tension and position of the
graft within the femoral and tibial tunnels,
are of prime importance for success of anterior
cruciate ligament (ACL) reconstruction.
Complications of harvest sites can impact the
graft quality as well as postoperative outcomes.
We hereby describe the complications
depending on the time of their onset on and on
the surgical technique used.
INTRA-OPERATIVE
COMPLICATIONS
Kenneth Jones (KJ) procedure with
bone-patellar tendon-bone (BPTB)
graft
Graft too thin/narrow
• It is typically recommended to harvest a graft
9 mm wide. In the past, double-bladed
bistouries produced narrower grafts,
measuring 7 to 8 mm.
• Insufficient graft width was also described
following double-incision techniques, due to
the surgical instrumentation used, and to
limited visibility of the patellar tendon during
harvesting (fig. 1).
‘Stripping’ of tendon near the patella
Incorrect use of gouge chisels, particularly
superficial insertion near the patella, could lead
to detachment of the patellar tendon from its
insertion site. In such cases, the tendon graft does
not incorporate a full bone plug, but rather pre-
patellar bone fragments. This complication could
compromise fixation within the bone tunnels.
GRAFT HARVESTING
COMPLICATIONS IN ANTERIOR
CRUCIATE LIGAMENT
RECONSTRUCTION
J. CHOUTEAU
Fig. 1:
Bone-Patellar Tendon-Bone (BTPB) graft
with thinning after harvesting using a double
incision approach.