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okay this is in acl surgery this is a bone patella tendon bone autograph so this has come out of the patient i just want to show you guys what we use here so this is used to reconstruct the acl so you can come in a little bit closer so btb is bone tendon bone this is off the tibia and this is off the patella and this is just about the central third of the patientamp;#39;s uh patella tendon and thatamp;#39;s going to be used to reconstruct their acl a couple of things here thereamp;#39;s a smaller piece of bone off the patella this is a suture that we use to guide it into the tunnel and once we fixated the graft on the femoral side we pulled tension here these are two bigger sutures and two of them on the tibial side to pull tension on the graft so that we can fix it under tension so weamp;#39;ve got the central third of the patientamp;#39;s patella tendon with bone on each side and thatamp;#39;s going to be used to reconstruct their anterior cruciate ligament this is how we deter