Adult Bone Patellar Tendon Bone (BPTB) Autograft

A Proven, High-Performance Graft for ACL Reconstruction
For active patients seeking long-term stability and performance following an ACL injury, the Bone–Patellar Tendon–Bone (BPTB) autograft is a trusted surgical option. Dr. Daniel Romanelli brings over two decades of advanced orthopedic experience to every ACL reconstruction, selecting the ideal graft to match each patient’s unique goals and anatomy.

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A Bone–Patellar Tendon–Bone autograft involves harvesting the central portion of the patellar tendon, along with small bone plugs from the kneecap (patella) and shinbone (tibia). This graft is then used to replace a torn anterior cruciate ligament (ACL) during reconstruction surgery.

Because it includes bone at both ends, the BPTB autograft offers secure bone-to-bone healing—which can result in faster integration and superior strength.
Often referred to as the “gold standard” for ACL reconstruction, the BPTB autograft offers several advantages:

Excellent Stability and Strength – Especially for pivot-heavy sports like soccer, football, and basketball

Fast Bone-to-Bone Healing – Shorter graft integration period compared to soft-tissue grafts

Low Risk of Graft Stretching or Failure – Ideal for high-demand athletes

Long-Term Durability – Proven success over decades of clinical use
Quadriceps tendon rupture repair is typically performed within days or weeks of the injury. Delaying treatment may make the repair more complex. During surgery, Dr. Romanelli reattaches the torn tendon to the kneecap using strong sutures and anchors, restoring the integrity of the extensor mechanism of the knee.

This outpatient procedure is performed under anesthesia and usually takes about one to two hours.
Dr. Romanelli may recommend a BPTB autograft for:

Competitive athletes or physically demanding professions

Younger patients with high activity levels

Patients seeking proven, long-term graft durability

Individuals with no history of significant kneecap pain or patellar tendon issues
The procedure is performed arthroscopically. A small section of the patellar tendon is harvested along with bone plugs. The damaged ACL is then replaced with the BPTB graft, secured into the femur and tibia with fixation devices that support strong healing.

Patients typically go home the same day and begin physical therapy shortly after.
Most patients experience the following recovery milestones:

Crutches for 1–2 weeks

Early range-of-motion therapy to reduce stiffness

Gradual strength and balance training at 2–3 months

Return to high-level sports between 6–9 months, based on progress and sport-specific demands

While some patients may experience mild anterior knee pain or kneeling discomfort, these symptoms often improve with guided rehab.

Dr. Romanelli: Expertise in Graft Selection

Choosing the right graft is key to successful ACL reconstruction. Dr. Romanelli evaluates each patient’s sport, body type, activity level, and goals to determine the best surgical option. Whether it’s a BPTB autograft, hamstring autograft, quadriceps autograft, or BEAR implant, every procedure is tailored to long-term outcomes and patient success.

Considering ACL surgery?
Schedule a consultation to find out if a BPTB autograft is the right solution for your knee recovery.

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