Graft Rotations Inside the Tibial During Anterior Cruciate Ligament Reconstruction with Bone–patellar Tendon–bone Graft is Effective Way to Avoid Graft Tunnel Mismatch

BackgroundThe 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.AimThe present study was conducted to study the effect of this technique on functional outcomes and graft failure rate.MethodsNinety-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.ResultsThe 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.ConclusionsRotation of graft inside the tibial tunnel is an effective way to deal with graft tunnel mismatch.