Graft rotations inside the tibial during anterior cruciate ligament reconstruction with bone–patellar tendon–bone graft is effective way to avoid graft tunnel mismatch

Abstract

Backgrounds: The graft tunnel mismatch is a well-known complication of bone-patellar tendon-bone (BPTB) graft in anterior cruciate ligament reconstruction (ACLR) surgery. In the present study, graft rotation technique is used to tackle this problem.Aim: The present study was conducted to study the effect of this technique on functional outcomes and graft failure rate.Methods: Ninety-nine patients who underwent ACL reconstruction using BPTB graft were enrolled in the study and depending upon the graft length these patients were divided into 2 groups. Group A-patients had no graft tunnel mismatch(n=67) and group B-patients had graft tunnel mismatch (n=32). In group B patients, the graft was rotated inside the tibial tunnel to manage the graft tunnel mismatch problem.Functional outcomes (Lysholm score and return to sports), knee laxity (KT-1000 difference), and graft rupture rate were compared between two groups.Results: The mean KT-1000 difference in group A was 2.11 mm and in group B was 2.03 mm (n.s.). There was no signi cant difference in mean Lysholm score (97 vs 97.3; p>0.05). 78% (49/67) of patients in group B and 73% (25/32) of patients in group A returned to the same or above level of pre-injury activity (n.s). The graft failure rate was 6% (4/67) in group A and 3% (1/32) in group B.Conclusions: Rotation of graft inside the tibial tunnel is an effective way to deal with graft tunnel mismatch.