A patellar tendon graft is usually performed using arthroscopic techniques. Using tiny incisions on the knee, the graft is taken from the middle third of your patellar tendon, including a small portion of attached bone at either end. A hole is drilled at an angle through the tibia and into the femur, following the path of the injured ACL (anterior cruciate ligament). The graft is then threaded through the holes, and the small pieces of bone at either end of the tendon are attached to the femur and the tibia, usually with screws or staples, which are left in place permanently. In time, the bone heals around the grafted tendon.