When performing the flipped BTB technique, which portion of the bone block should face away from the tendon?

In the flipped bone-tendon-bone (BTB) technique, the cancellous portion of the bone block should face away from the tendon. This is because the cancellous bone is typically less dense and has a higher surface area for enhancing graft incorporation into the recipient site. Placing the cancellous side outward allows for better integration with the surrounding biological tissue, promoting healing and stability.

On the other hand, the cortical side, being denser and stronger, is designed to face towards the tendon. This configuration provides structural support, allowing for optimal load transfer during activity and ensuring that the graft retains its tensile strength. The distinction between cancellous and cortical bone is critical in surgical techniques focused on graft implantation, as the orientation can significantly affect the outcome of the procedure.