Quadrant Specific Tibial Interference Screw Fixation Allows Constant Displacement of Soft Tissue Grafts Inside Misplaced Tibial Tunnels: A Porcine Anterior Cruciate Ligament Quantitative Assessment Study

Abstract

Background The most common technical error during anterior cruciate ligament (ACL) reconstruction is incorrect tunnel placement. It remains unclear if a misplaced tibial tunnel may be corrected intraoperatively.

Aim To measure the displacement of soft-tissue grafts with tibial interference screws.

Materials and Methods Ex-vivo experimental study in 28 porcine knees. The flexor tendon of the posterior limb was harvested, doubled and sized to fit through a 9-mm misplaced tibial tunnel. The specimens were divided into 4 groups according to the quadrant of entry (anterior [A], posterior [P], medial [M], or lateral [L]) of a 9-mm tibial interference screw in relation to the graft. A millimetric ruler was placed at the tibial plateau, which was photographed with a an EOS T6 (Canon Inc., Ōta, Tokio, Japan) camera, and the image was digitalized and scaled to size. The length and direction of the graft displacements were measured with Adobe Photoshop CC 2019 (San José, CA, US). The mean differences among the groups were analyzed through one-way analysis of variance (ANOVA). The statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, US) software, version 25.0 (p ≤ 0.05)

Results The mean lengths of the graft displacements were similar among the groups: A – 4.4 mm; P –4.6 mm; M – 4.5 mm; and L – 4.3 mm, without statistically significant differences (p = 0.894). The mean directions of the graft displacements were also similar among the groups: A – 176° (standard deviation [SD]: ± 15.4°); P – 165° (SD: ± 16.6°); M – 166° (SD: ± 12.1°); and L – 169° (SD: ± 10.6°). No statistically significant differences were found (p = 0.42).

Conclusions Regardless of the entry quadrant, constant graft displacement to the opposite side was observed when the tibial screw reached the articular surface. Clinical relevance: a misplaced tibial tunnel may be corrected intraoperatively with a quadrant-specific screw, which must reach the articular surface to produce an effective graft displacement. Nevertheless, we cannot predict the magnitude of this error in every poorly-drilled tibial tunnel; it should be assessed case by case.

Keywords

anterior cruciate ligament - soft-tissue graft - tibial tunnel - screw displacement

Statement of Authenticity

The present research is original, and all the information was duly cited, ruling out plagiarism.

Publication History

Received: 27 April 2021

Accepted: 07 December 2021

Article published online:
20 May 2022

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