Prevention of graft-tunnel mismatch during anatomical anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft.
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.
Lenox Hill Hospital, 210 East 64th Street, 4th Floor, New York, New York 10065, USA.
C K
CK
Boddu
Yenepoya Medical College, Mangalore, Karnataka, India.
S K
SK
Arif
Yenepoya Medical College, Mangalore, Karnataka, India.
M M
MM
Hussain
Hamad Medical Corporation, Ottapalam, Kerala, India.
S
S
Sankaranarayanan
Hamad Medical Corporation, Doha, Qatar.
S
S
Hameed
Kasturba Medical College, Mangalore, Karnataka, India.
P R
PR
Sujir
D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D064594:Bone-Patellar Tendon-Bone Grafts; D005269:Femur / Q000033:anatomy & histology / Q000601:surgery; D006801:Humans; D007194:India; D008297:Male; D010027:Osteotomy; D017847:Patellar Ligament / Q000033:anatomy & histology / Q000601:surgery; D013977:Tibia / Q000033:anatomy & histology / Q000601:surgery; D016896:Treatment Outcome
Anatomic ACL reconstruction; BPTB graft; Femoral tunnel length; Graft-Tunnel mismatch; Patellar tendon length; Predict bone plug length; Reconstructed ACL length; Tibial tunnel length