Minimally invasive two-incision bone–patellar tendon–bone autograft harvesting of the knee using a low-profile cutting guide: A current technique

The bone-patellar tendon-bone (BPTB) graft is a reference autograft for anterior cruciate ligament reconstruction because of its consistent dimensions and early bone-to-bone healing. However, traditional harvesting through a long anterior incision is associated with donor-site morbidity, including anterior knee pain, sensory disturbance, and, rarely, patella fracture. This current technique describes a minimally invasive two-incision BPTB harvesting method using a low-profile cutting guide device. It is indicated for primary reconstruction in active patients who require reliable graft fixation. The key steps are careful dissection of the paratenon, stable fixation of a positioning guide with Kirschner wires, and advancement of a sliding tendon cutter along the fixed guide. This guided track standardizes the graft width at 10 mm and protects the tendon and paratenon. The depth of the patellar bone cut is limited to reduce the risk of fracture. In our early single-center experience, graft width was reproducible (10.0-10.2 mm), and there was no tendon transection or patella fracture. Arthroscopy confirmed preservation of the paratenon, and anterior knee pain and localized numbness were uncommon at short-term follow-up. The instruments, the step-by-step technique, and pearls and pitfalls are presented with an operative video. LEVEL 1: Knee. LEVEL 2: Anterior cruciate ligament reconstruction - autograft harvesting.