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The current study was performed to understand the relationship between graft length placed within the bone tunnel and intraosseous graft healing in anterior cruciate ligament reconstruction. Twenty-four adult beagle dogs were divided into two groups of 12 animals each. In each animal, anterior cruciate ligament reconstruction using a 4-mm diameter autogenous flexor tendon graft was done in the left knee. In Groups I and II, the graft having a length of 15 mm and 5 mm, respectively, was placed within the tibial tunnel. The proximal end of the graft was placed through the over-the-top route in all animals. In each group, 5 animals were sacrificed immediately after surgery, and the remaining 7 were sacrificed at 6 weeks postoperatively. Biomechanical and histologic evaluations were performed. In pull-out testing, the ultimate failure load and the linear stiffness of the graft-tibia complex harvested at 6 weeks were significantly greater than those harvested at the time-zero period. There were no significant differences in those parameters between Groups I and II at 6 weeks. In each group, the perpendicular collagen fibers connecting the tendon to the bone tunnel wall were observed only in the narrow area located close to the intraarticular tunnel outlet. In conclusion, excessively long placement of the flexor graft within the bone tunnel does not result in an additional increase of anchoring strength and stiffness of the graft in anterior cruciate ligament reconstruction.

Application of growth factors is a possible strategy to prevent graft deterioration in anterior cruciate ligament reconstruction.

Surgeons need not be overly concerned about minor graft-tunnel diameter disparities.