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Preoperative Templating of Bone-Patellar Tendon-Bone Graft for ACL Reconstruction: An Individualised Morphometry-Based Graft Harvest Method

2023 Congress Paper Abstracts

Preoperative Templating of Bone-Patellar Tendon-Bone Graft for ACL Reconstruction: An Individualised Morphometry-Based Graft Harvest Method

Prakash Ayyadurai, MS, INDIA Arumugam Sivaraman, MS(Orth), AB(IM)(USA), FRCS(Glasg), INDIA Suresh Perumal, MS(Orth), INDIA Janani Gopalakrishnan, MD (Sports Medicine), INDIA

Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamilnadu, INDIA

2023 Congress   ePoster Presentation   2023 Congress   Not yet rated


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Anatomic Structure

Diagnosis / Condition

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Diagnosis Method

Sports Medicine

Summary: Explains how to harvest a near-perfect individualised BPTB graft using morphometric measurements of each patient.


Knowledge of anatomy and morphometry of the patella and patellar tendon is crucial for the selection of bone-patellar tendon-bone (BTB) graft for ACL reconstruction. Graft tunnel mismatch in BTB graft especially in patients with patella alta or baja can result in compromised fixation for the bone-to-bone healing. This complication can be avoided by proper templating of graft using parameters measured from magnetic resonance imaging (MRI). The study aimed to derive morphometric data from MRI and predict the suitability of BTB graft preoperatively.

Materials And Methods

MRI of 1,002 knees was chosen from database after applying the eligibility criteria which included individuals in the age group of 18-50 years (both sex) with the intact patella and patellar tendon. Individuals with pathologies of the knee joint and associated structures such as patellar fracture/dislocations, fractures of the distal femur and proximal tibia, and avulsion of the quadriceps tendon or patellar tendon were excluded. For analysis, 1.5 Tesla, proton density, and fat-suppressed sequences of sagittal and axial sections of T2-weighted MRI images were used.


Mean age of the 1,002 patients was 35.45 years and there were 290 women and 712 men. Respective measurements were as follows: patella length, width, and thickness, 40.38mm, 40.24mm, and 18.69mm, respectively; patellar tendon length, width, and insertional dimensions, 45.2mm, 27.2mm, and 6mm, respectively; Insall-Salvati ratio, 1.13; overall graft length, 90.2mm; and effective tendon length, 26.1mm. Conclusion: A simple MRI analysis can give us valuable inputs on BTB graft morphometry. The values can also help us with the near-perfect graft harvest. The intraoperative complication of graft tunnel mismatch can be avoided by predicting the overall graft length, effective tendon length, tibial tunnel length, and patellar position using the measured parameters on MRI.

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