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the graph that is taken from the middle third of the patellar tendon is about 10 centimeters long it incorporates a plug of bone from the lower part of the knee cap on one end and a piece of bone from the upper tibia on the other end the defect in the patellar tendon is closed the tendon heals and eventually regains its strength this graft can also be taken from a cadaver this has some advantages but also some risks the rest of the operation is performed with the aid of the arthroscope while viewing the inside of the knee on a television monitor the arthroscope is introduced into the knee and the joint is inspected any associated problems such as torn cartilage is corrected to create a tunnel in the proper location in the tibia a guide pen is passed through the upper tibia it enters the joint at the spot where the ACL normally attaches to the tibia the guide pen is over drilled with a cannulated drill a guide pin is now passed through the tibia tunnel and into the femur it is drilled
