Skip to main content
SpringerLink
Log in

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

  • Research
  • Published:
Sport Sciences for Health Aims and scope Submit manuscript

Abstract

Background

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 two 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 significant 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data for this study is included in the manuscript.

Abbreviations

ACL:

Anterior cruciate ligament

BPTB:

Bone–patellar tendon–bone

ACLR:

Anterior cruciate ligament reconstruction

References

  1. Moses B, Orchard J, Orchard J (2012) Systematic review: annual incidence of ACL injury and surgery in various populations. Res Sports Med 20(3–4):157–179

    Article  PubMed  Google Scholar 

  2. Piatti M, Ambrosi E, Dedda G, Omeljaniuk RJ, Turati M, Bigoni M et al (2022) Jump performance during a season in elite volleyball players. J Sports Med Phys Fit 62(5):602–608

    Google Scholar 

  3. Gupta R, Kapoor A, Soni A, Khatri S, Masih GD, Raghav M (2020) No difference in outcome of anterior cruciate ligament reconstruction with “bone–patellar tendon–bone versus semitendinosus-gracilis graft with preserved insertion”: a randomized clinical trial. Indian J Orthop 54(5):665–671

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gupta R, Kapoor A, Soni A, Khatri S, Masih GD (2020) Anterior cruciate ligament reconstruction with bone–patellar tendon–bone graft is associated with higher and earlier return to sports as compared to hamstring tendon graft. Knee Surg Sports Traumatol Arthrosc 28:3659–3665

    Article  PubMed  Google Scholar 

  5. Turati M, Caliandro M, Gaddi D, Piatti M, Rigamonti L, Zanchi N et al (2022) Clinical outcomes and complications after anterior cruciate ligament reconstruction with bone–patellar tendon–bone in patient Tanner 3 and 4: a systematic review. Eur J Orthop Surg Traumatol 2022:1–9

    Google Scholar 

  6. Boddu C, Arif S, Hussain M, Sankaranarayanan S, Hameed S, Sujir P (2015) Prevention of graft-tunnel mismatch during anatomical anterior cruciate ligament reconstruction using a bone–patellar tendon–bone graft. Bone Joint J 97(3):324–328

    Article  PubMed  Google Scholar 

  7. Goldstein JL, Verma N, McNickle AG, Zelazny A, Ghodadra N, Bach BR Jr (2010) Avoiding mismatch in allograft anterior cruciate ligament reconstruction: correlation between patient height and patellar tendon length. Arthrosc J Arthrosc Relat Surg 26(5):643–650

    Article  Google Scholar 

  8. Brown JA, Brophy RH, Franco J, Marquand A, Solomon TC, Watanabe D et al (2007) Avoiding allograft length mismatch during anterior cruciate ligament reconstruction: patient height as an indicator of appropriate graft length. Am J Sports Med 35(6):986–989

    Article  PubMed  Google Scholar 

  9. Navali AM, Jafarabadi MA (2015) Is there any correlation between patient height and patellar tendon length? Arch Bone Joint Surg 3(2):99

    PubMed  PubMed Central  Google Scholar 

  10. Shaffer B, Gow W, Tibone JE (1993) Graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction: a new technique of intraarticular measurement and modified graft harvesting. Arthrosc J Arthrosc Relat Surg. 9(6):633–646

    Article  CAS  Google Scholar 

  11. Spindler KP, Bergfeld JA, Andrish JT (1993) Intraoperative complications of ACL surgery: avoidance and management. Orthopedics 16(4):425–430

    Article  CAS  PubMed  Google Scholar 

  12. Ko D, Kim H-J, Oh S-H, Kim B-J, Kim S-J (2018) How to avoid graft-tunnel length mismatch in modified transtibial technique for anterior cruciate ligament reconstruction using bone–patellar tendon–bone graft. Clin Orthop Surg 10(4):407

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grawe B, Smerina A, Allen A (2014) Avoiding graft-tunnel length mismatch in anterior cruciate ligament reconstruction: the single-bone plug technique. Arthrosc Tech 3(3):e417–e420

    Article  PubMed  PubMed Central  Google Scholar 

  14. Robin BN, Lubowitz JH (2014) Disadvantages and advantages of transtibial technique for creating the anterior cruciate ligament femoral socket. J Knee Surg 27(05):327–330

    Article  PubMed  Google Scholar 

  15. Kim DW, Roh KJ, Yoo WK, Chung IH (1995) The calculation of the tibial tunnel depth in the endoscopic ACL reconstruction. Knee Surg Relat Res. 1995;7(1):21–25.

    Google Scholar 

  16. Tudisco C, Bisicchia S (2012) Drilling the femoral tunnel during ACL reconstruction: transtibial versus anteromedial portal techniques. Orthopedics 35(8):e1166–e1172

    Article  PubMed  Google Scholar 

  17. Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75(12):1795–1803

    Article  CAS  PubMed  Google Scholar 

  18. Qi L, Chang C, Jian L, Xin T, Gang Z (2011) Effect of varying the length of soft-tissue grafts in the tibial tunnel in a canine anterior cruciate ligament reconstruction model. Arthroscopy 27(6):825–833

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Sports Injury Department, Fortis, Mohali, India

    Ravi Gupta

  2. Orthopaedics Department, Healthsure Hospital, Mohali, India

    Anil Kapoor

  3. Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India

    Akash Singhal, Sandeep Singh & Manharjot Singh Malhi

Authors
  1. Ravi Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anil Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akash Singhal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandeep Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manharjot Singh Malhi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study's conception and design. All surgeries were performed by Dr. RG. Primary manuscript writing and methodology were set by Dr. AK. Dr. AS and Dr. SS were involved in data collection and Dr. MSM did final proofing and statistical analysis of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anil Kapoor.

Ethics declarations

Conflict of interest

The authors have no conflict of interest.

Informed consent

Informed and written consent was received from all the patients.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/ or national research committee and with the 1964 Helsinki Declaration and its later amendments or camparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, R., Kapoor, A., Singhal, A. et al. Graft rotations inside the tibial during anterior cruciate ligament reconstruction with bone–patellar tendon–bone graft is effective way to avoid graft tunnel mismatch. Sport Sci Health 20, 103–107 (2024). https://doi.org/10.1007/s11332-023-01071-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11332-023-01071-x

Keywords

Search

Navigation