Introduction Autogenous bone-patellar tendon-bone (BPTB) is the most frequent graft used for anterior cruciate ligament (ACL) reconstruction. The central third of the patella as well as the medial third have been used as a BPTB graft by several authors [8, 9, 10]. There are a few reports of patellar frac- tures associated with central-third BPTB, but this compli- cation is either infrequent or unreported [1, 2, 3, 4, 5, 6, 7, 11, 12, 13]. Since 1983, when McCarrol reported the first case of patella fracture that occurred 6 months postopera- tively during a golf swing, few other authors have reported this complication. Patellar fractures associated with the use of the medial- third BPTB autograft have not been reported. The objective of our study is to report four cases of patellar fractures us- ing the medial-third patellar tendon graft. Case reports Between 1992 and 1999, over 478 patients underwent an ACL re- construction using an ipsilateral BPTB graft. The medial third of the patellar ligament was used as bone-tendon-bone graft, accord- ing to the press-fit technique described by Peter Hertel in Berlin in 1992 [8]. We reviewed 478 patients retrospectively. The patellar bone block was harvested with a small saw blade in the shape of a “flag” (approximately 25×20×6 mm), and it had a triangular shape in cross section. The graft was stabilized without screws in the femur and tibia by press-fit. Postoperatively, the patient was allowed to bend the knee between 10° and 90° and to walk with two crutches. A brace was used to protect the knee during walking as well as during the night. Full range of motion and full weight bearing were allowed after 6 weeks [8]. Only four patients were complicated with patellar fracture (Table 1). Case 1 A 20-year-old woman sustained a rupture of the ACL in a motor vehicle accident. Five days later, the ACL was reconstructed. Two months after operation, she sustained a direct low-energy contusion Abstract Patella fractures following anterior cruciate ligament (ACL) re- construction are a recognized but rarely reported complication. To our knowledge, 24 reports of patella fractures after ACL reconstruction using the central-third patella-tendon autograft have been reported in the literature. Patellar fractures associ- ated with the use of the medial-third bone-patellar tendon-bone autograft have not been reported. This article describes four cases of patellar frac- tures in 478 ACL reconstructions be- tween 1992 and 1999, using the me- dial third of the patellar tendon graft. All of them were transverse fractures of the patella but only one was dis- placed. All patients suffered local in- jury to the donor knee between 2 and 4 months postoperatively. No signifi- cant differences in the final outcome were noticed between the cases com- plicated with patellar fracture and those with uncomplicated ACL re- constructions. Keywords Anterior cruciate ligament reconstruction · Patella fracture · Bone-patellar tendon-bone · Complication KNEE Knee Surg, Sports Traumatol, Arthrosc (2001) 9 : 151–154 DOI 10.1007/s001670100207 Christos D. Papageorgiou Vassilios K. Kostopoulos Ulf G. Moebius Kalliopi A. Petropoulou Anastasios D. Georgoulis Panagiotis N. Soucacos Patellar fractures associated with medial-third bone-patellar tendon-bone autograft ACL reconstruction Received: 14 February 2000 Accepted: 10 January 2001 Published online: 20 April 2001 © Springer-Verlag 2001 C.D. Papageorgiou (✉) · V.K. Kostopoulos · U.G. Moebius · A.D. Georgoulis · P.N. Soucacos Department of Orthopaedic Surgery, University of Ioannina, Medical School, 45110 Ioannina, Greece e-mail: grakos @otenet.gr, Tel.: +30-651-74612, Fax: +30-651-74770 K.A. Petropoulou Department of Radiology, University of Ioannina, Medical School, 45110 Ioannina, Greece