Autograft bone-patella tendon-bone plug comminution with loss of ligament fixation and stability

Two cases are described in which bone plug comminution caused a loss of femoral fixation after endoscopic bone-patellar tendon-bone, anterior cruciate ligament autograft reconstruction. Clinically there was loss of knee joint stability, and radiographically the bone graft had dislodged. One case was salvaged by graft inversion, with femoral interference screw and tibial traction suture fixation. The second case required graft replacement with a patella bone-quadriceps tendon autograft.