A technique for resolution of graft-tunnel length mismatch in central third bone-patellar tendon-bone anterior cruciate ligament reconstruction

The existence of graft-tunnel length mismatch in correctly reconstructed anterior cruciate ligament (ACL)-deficient patients can occur due to both anatomic variation and compromised tunnel placement encountered during revision, despite attempts at prevention with accurate measurement techniques. This study reports a method for resolution of graft-tunnel length mismatch during central third bone-patellar tendon-bone ACL reconstruction. The technique involves rotation of the graft to shorten its length. Variation in graft shortening occurs depending on the direction of rotation, with external rotation achieving greater shortening. At 630 degrees of external rotation, approximately 25% shortening of the collagenous portion of the graft can be achieved, which allows for adequate bitunnel interference fixation in most instances. This technique can be used during difficult ACL reconstructions, both primary and revision, and may also have uses in routine reconstructions. Early clinical results are presented.