09/03/2025
Advantages of Patellar Tendon(BPTB) Grafts:
1. Bone-to-Bone Healing
BPTB: Has bone plugs on both ends → heals with bone-to-bone incorporation in tunnels, which is faster and more reliable (6–8 weeks).
QT: Usually soft-tissue only (unless harvested with bone block, which is less common) → tendon-to-bone healing is slower and biologically less predictable.
2. Proven Track Record
BPTB: Decades of registry and RCT data showing low graft failure rates, particularly in adolescents and young pivoting athletes.
QT: Promising but still lacks the same long-term, high-volume evidence supporting durability and return to play.
3. Lower Graft Failure Risk in Young Athletes
BPTB: Consistently associated with lower rerupture and revision rates compared with hamstring and, in some series, quadriceps tendon autografts — especially in teens and athletes in cutting/pivoting sports.
QT: Early results are encouraging, but some studies still show slightly higher revision rates in high-risk populations.
4. Firm, Rigid Fixation
BPTB: Bone plugs allow interference screw fixation → strong initial stability.
QT: Fixation can be trickier, especially with all–soft tissue grafts; often relies on suspensory devices, which may allow micromotion in tunnels.
5. Restoration of Knee Stability
BPTB: Historically shows lower residual laxity on instrumented testing (KT-1000/2000) compared to hamstring and sometimes QT grafts.
QT: Early stability data are good, but long-term comparative studies are limited.
6. Standard of Care in Elite Athletes
NFL/NCAA registries show the vast majority of elite athletes receive BPTB grafts — partly due to the above advantages and surgeon preference.
This strong precedent supports its continued reputation as the “gold standard” graft.
