Intra-femoral tunnel graft lengths less than 20mm do not predispose to early graft failure, inferior outcomes or poor function. A prospective clinico-radiological comparative study.

Abstract

Increasing demands on skills with mounting pressures from expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions requires precise knowledge of technical details by surgeons. One such element is the minimum length of graft in femoral tunnel to allow for adequate tendon-to-bone healing and early return to activities and sports. This has, however, remained an unanswered question. To study and compare clinico-radiological outcomes of ACL reconstructions in patients with < 20mm of intra-femoral tunnel graft length with those measuring ≥ 20mm. All eligible patients undergoing arthroscopic ACL reconstruction were sequentially divided into two groups based on the intra-femoral tunnel graft lengths (A: < 20mm, n = 27; and B: ≥ 20mm, n = 25). Exclusions were made for those > 45years of age, with chondral and/or multi-ligamentous injuries and with systemic pathologies. All patients were postoperatively evaluated in clinics by physical examination and functional scoring (Lysholm and modified Cincinnati scores) at 3, 6 and 12-month intervals. Graft vascularity was assessed by signal-to-noise quotient ratio (SNQR) using magnetic resonance imaging (MRI) at 3 and 12months. No significant differences were noted in mean Lysholm and modified Cincinnati scores between the two groups at the end of 1year. There were also no significant differences in graft maturation over time and SNQR at 3 and 12months in the region of interest (ROI). Intra-femoral tunnel graft length of less than 20mm does not compromise early clinical and functional outcomes of ACL reconstructions.