Migration of bone graft post-ACL repair

Case contributed by Suraindra Mark Rajadurai
Diagnosis certain


Knee injury playing AFL football, complete ACL tear confirmed with MRI. D1 post ACL repair.

Patient Data

Age: 25 years old
Gender: Male

D1 post-op


Sheet like calcific density projected within the patella tendon and adjacent the tibial insertion. Further calcific density can be seen in a dependent position posterior to the femoral condyles.

Recent ACL repair. Intra-articular gas and effusion in keeping with the recent surgery.



The sheet-like calcific density within the tendon and the intra-articular densities have almost completely resolved post-washout.

A small amount of dependent density can still be seen in the posterior aspect of the joint.

Case Discussion

ACL repair can be performed using a BTB (bone-tendon-bone) autograft, often taken from the patellar tendon.

In this case a synthetic bone graft (Bonalive) was used to repair the patella harvest site. Unfortunately the graft material migrated into the tendon defect and can be seen outlining the patella tendon. 

This was identified on the D1 post-operative radiograph and the patient returned to theater for washout. They made an otherwise uncomplicated recovery.


Operation Report:

Knee Washout, Left knee washout, Left, Knee
GA, Supine, IV abs, Prep and Drape

Previous incision opened
Bonalive washout out from tendon defect.  Radiological appearance worse than clinical findings at surgery.
2L washout of patella tendon defect.

Closure in layers

2.0 vicryl
3.0 monocryl

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