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iamp;#39;m dr karen sutton an orthopedic surgeon in sports medicine at hss today iamp;#39;ll be demonstrating a suspended btb acl reconstruction technique using the rigid loop btb adjustable button this is our bone patella tendon bone graft that weamp;#39;re going to be using for our suspensory acl reconstruction a couple key points since weamp;#39;re doing the suspensory fixation and we use the twister guide a retro grade reamer focusing on the femoral aspect of the graft itamp;#39;s really important that the femoral aspect of the graft is going to be less than 20 millimeters in length here we have the graft thatamp;#39;s 18 millimeters in length on the femoral bone side the other key point for the femoral side in order for assuring passage through the femoral tunnel is to keep this bulleted devoid of any extra soft tissue and so that it can pass nicely through the femoral socket we also have the two drill holes here itamp;#39;s important to have the leading drill hole slightly