Clin Orthop Surg.  2018 Dec;10(4):407-412. 10.4055/cios.2018.10.4.407.

How to Avoid Graft-Tunnel Length Mismatch in Modified Transtibial Technique for Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft

Affiliations
  • 1Department of Orthopedic Surgery, Konkuk University School of Medicine, Chungju, Korea. kodukan@naver.com
  • 2Department of Orthopedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.

Abstract

BACKGROUND
We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft.
METHODS
The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels − the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients.
RESULTS
There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001).
CONCLUSIONS
Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.

Keyword

Anterior cruciate ligament reconstruction; Modified transtibial technique; Bone-patellar tendon-bone grafts; Graft-tunnel length mismatch; Bone block length

MeSH Terms

Anterior Cruciate Ligament Reconstruction*
Anterior Cruciate Ligament*
Body Mass Index
Bone-Patellar Tendon-Bone Grafts
Female
Humans
Knee
Linear Models
Male
Outcome Assessment (Health Care)
Patellar Ligament
Retrospective Studies
Tears
Transplants*

Figure

  • Fig. 1 A) Measurement of femoral tunnel (FT) length, inter-tunnel distance (IT), tibial tunnel (TT) length, and the total length (FT + IT + TT). (B) Tunnel length measurement was done using an arthroscopic ruler. (C) The tunnel length gauge was used to double-check the tunnel length.

  • Fig. 2 Ideal length of patellar bone block and tibial bone block of bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction: [total tunnel length (femoral tunnel + inter-tunnel distance + tibial tunnel) − patellar tendon length] / 2.


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