Avoiding Graft-Tunnel Length Mismatch in Anterior Cruciate Ligament Reconstruction: The Single–Bone Plug Technique

• Main Authors: Brian Grawe, M.D., Amber Smerina, P.A.C., Answorth Allen, M.D.
• Format: Article
• Language: English
• Published: Elsevier 2014-06-01
• Series: Arthroscopy Techniques
• Online Access: http://www.sciencedirect.com/science/article/pii/S2212628714000346

Anterior cruciate ligament reconstruction, using autogenous bone–patellar tendon–bone (BTB) as a graft material, is commonly performed in the setting of anterior cruciate ligament insufficiency. Although bone–patellar tendon–bone autograft has an extensive track record, showing excellent clinical results, donor-site morbidity and graft-tunnel mismatch can still be problematic for a subset of patients. In the setting of a tendon graft that is too long, adequate interference screw fixation cannot be obtained, typically resulting in a tibial-sided bone plug that achieves less than 15 to 20 mm of bone in the distal tibial tunnel. We present an easy and effective technique for avoiding the graft-tunnel mismatch problems that commonly occur in patients who have an excessively long patellar tendons. This technique involves a simple preoperative planning algorithm that ultimately results in a single tibial-sided plug harvest. Bony interference fixation is then obtained on the femoral side and soft-tissue fixation on the tibial side. This technique allows for satisfactory graft fixation while avoiding the donor-site morbidity associated with patellar bone plug harvest.