Graft

Patellar tendon graft

The bone–patellar tendon–bone graft, its characteristics, potential benefits, and donor-site morbidity.

Reading time: 4 min · Last updated 31/08/2026

The bone–tendon–bone principle

A central strip of the patellar tendon is harvested with two small bone plugs, fixed into the tunnels of the tibia and femur.

Bone-to-bone healing is an argument for this technique, which has been used for a long time.

Why suggest it?

It offers robust fixation and extensive long-term data. It may be discussed for athletes exposed to pivoting and contact.

However, the choice is not automatic and must integrate professional activity and tolerance of the harvest site.

Anterior pain and kneeling

Front-of-knee pain, discomfort when kneeling, and quadriceps deficit are specific issues. Complications from bone harvesting are rare but possible.

Attentive recovery of extension and progressive loading of the extensor mechanism are important.

Put kneeling activities on the table

Floor work, DIY, religious practices, or sports that require kneeling are important information before this harvest. They allow for an honest discussion about potential anterior discomfort.

Ask what is planned for pain management and which signs at the harvest site should be reported.

List activities with prolonged kneeling.
Report pre-existing patellar pain or anterior tendinopathy.

Anticipating load on the front of the knee

The patellar tendon transmits the force of the quadriceps to the leg. The harvest may make certain anterior tasks—stair descent, kneeling, jumping, or prolonged kneeling—more sensitive at first. Anterior pain has several possible causes and should not be automatically attributed to the graft; mobility, loading, and other tissues are also considered.

State if your work requires you to kneel, carry things while kneeling, or climb stairs frequently. Ask how extension, anterior pain, and rare signs linked to the bone harvest will be monitored.

These benchmarks serve to prepare for a clinical exchange and to understand the possible choices. They do not allow for remote conclusions regarding an injury, treatment, or schedule: the context, examination, and any associated procedures remain determining factors.

To delve deeper into the "Patellar tendon graft," revisit the elements from the "The bone–tendon–bone principle" and "Why suggest it?" sections with your own timeline. It is useful to separate what is certain—date of trauma, report, triggering activity—from what remains an impression, such as the feeling of weakness or giving way. This distinction makes information easier for the team to interpret.

The cited publications describe populations and trends; they do not replace the instructions of the team that knows your file. During the consultation, ask how general information applies or does not apply to your situation, what its limitations are, and what sign would justify re-contacting them before the scheduled follow-up.

After the exchange, note the next step, the person to contact, and the symptoms to monitor. If an answer seems contradictory to a report or written instruction, ask for clarification rather than modifying weight-bearing, activities, or medications on your own.

Medical disclaimer

This content is for information only and is not a diagnosis or personalised recommendation. It does not replace an examination by a doctor, surgeon, or physiotherapist. In an emergency or if symptoms worsen, contact a healthcare professional promptly.

Frequently asked questions

Can I kneel afterwards?

Often yes eventually, but discomfort may persist in some people; this is important to discuss for jobs involving kneeling.

Is it reserved for professional athletes?

No. The indication is based on a set of factors, not professional status.

Is the scar larger?

It may be more visible than for some other grafts, but its appearance varies and evolves over time.

Does anterior pain prevent any return to activity?

No, but it must be evaluated and the load adapted with the team rather than ignored.