Prevention of graft-tunnel mismatch during anatomical anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft

Abstract

Graft-tunnel mismatch of the bone-patellar tendon-bone (BPTB) graft is a major concern during anatomical anterior cruciate ligament (ACL) reconstruction if the femoral tunnel is positioned using a far medial portal technique, as the femoral tunnel tends to be shorter compared with that positioned using a transtibial portal technique. This study describes an accurate method of calculating the ideal length of bone plugs of a BPTB graft required to avoid graft-tunnel mismatch during anatomical ACL reconstruction using a far medial portal technique of femoral tunnel positioning. Based on data obtained intra-operatively from 60 anatomical ACL reconstruction procedures, we calculated the length of bone plugs required in the BPTB graft to avoid graft-tunnel mismatch. When this was prevented in all the 60 cases, we found that the mean length of femoral bone plug that remained in contact with the interference screw within the femoral tunnel was 14 mm (12 to 22) and the mean length of tibial bone plug that remained in contact with the interference screw within the tibial tunnel was 23 mm (18 to 28). These results were used to validate theoretical formulae developed to predict the required length of bone plugs in BPTB graft during anatomical ACL reconstruction using a far medial portal technique.

Six Percent Incidence of Graft-Tunnel Mismatch in Anatomic Anterior Cruciate Ligament Reconstruction Using Bone-Patella Tendon-Bone Autograft and Anteromedial Portal Drilling

“…However, over the past two decades, there has been increased use of anteromedial portal methods to drill femoral tunnels in ACLR. This shift in technique is in accordance with evidence that anteromedial portal drilling can change the position, length, and obliquity of the femoral tunnel in comparison to transtibial drilling, 7 , 8 , 9 position the tunnel at the center of the native ACL attachment site, 10 , 11 recreate the anisometry of the native ACL compared to transtibial techniques 12 , 13 , and thus, potentially influence mismatch 14 , 15 , although evidence of clinically superior outcomes is lacking. 16 However, the true incidence of mismatch using anteromedial drilling techniques is unknown.…”

Current concepts in graft selection for anterior cruciate ligament reconstruction

“…Mismatch of BPTB graft and tunnel length may also lead to a small tibial bone plug and compromise the strength of the fixation. 15 Studies on BPTB autograft show excellent functional outcomes and return to sporting function but anterior knee pain remains the long-term drawback of this technique. The minimally invasive approach to BPTB graft harvest is reported to reduce the incidence of anterior knee pain; however, there is limited evidence within the current literature.…”

Bone–Patellar Tendon–Bone Autografts Versus Hamstring Autografts Using the Same Suspensory Fixations in ACL Reconstruction: A Systematic Review and Meta-analysis

“…24 Moreover, with the popularization of anatomic ACLR, the femoral tunnel is placed lower on the lateral wall of the intercondylar notch, which can lead to issues with graft passage and the likelihood of graft-tunnel mismatch. 6 Employing suspensory fixation can solve these problems, 24 especially when it is difficult to preserve sufficient bone stock in the bone tunnel or when it is at risk of posterior wall blowout. Moreover, suspensory fixation can be a solution when an interference screw is inapplicable in revision cases with tunnel enlargement.…”