Suture holes in anterior cruciate ligament bone-patellar tendon-bone grafts.

Anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft is a common and technically demanding surgery. Traditional preparation of the femoral bone plug includes 2 transcortical holes with leading sutures to pull the graft into the knee. The pull of the sutures and patellar tendon are not colinear with the bone plug and femoral socket. The bone plug tilts, thus impairing passage into the femoral socket. A new preparation technique was devised that, by changing the location of the suture holes, decreases graft tilting and improves passage. In our study, traditional and new techniques of femoral bone plug preparation were investigated by force diagramming and then graft modeling. Bone plug tilting was caused by the trailing pull of the patellar tendon eccentric to the plug and socket. By preparing the femoral bone plug with a diametric, transverse trailing suture hole, the plug became colinear with the femoral socket for easier passage. The new technique was then surgically implemented with straighter and faster graft passage.