- Technique: Cancellous bone is obtained from the lateral femur with a large curette through the fenestration made for the reamer. During the entire reaming procedure a large sucker is used to remove the loose fragments and blood from the cavity. Periodically during the procedure, the contents of the sucker are emptied into the bone graft dish. A large amount of free bone is procured in this manner. Loose bone graft can then be placed into the cavity with the use of an impacter device. In pediatric patients this impacter can be fashioned from a 10 cc syringe with a hole cut in the distal side. On the surface of the custom impacter there is a scale which gives the exact length of the cavity so that the fibular graft can be cut. The impacter has a side window at the area of the subchondral bone. This window can be adjusted to place the cancellous graft into the desired position. Contrast material is used again to ensure that the cavity has been restricted by the bone graft.