Tibial tunnel bone grafting: a new technique for dealing with graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction.

A problem that is frequently encountered during endoscopic anterior cruciate ligament reconstruction bone-patellar tendon-bone autograft is that the graft is often too long and protrudes from the tibial tunnel. If less than 20 mm of the bone plug remains in the tibial tunnel, interference screw fixation cannot safely be used, and an alternate form of fixation may have to be employed. A simple technique has been developed to deal with this problem. The technique involves bone-grafting the tibial tunnel with a cancellous core of bone that is removed while creating the tibial tunnel. This not only makes it possible to safely use interference screw fixation in all cases, but it also makes it possible to place the point of graft fixation very near the anatomic anterior cruciate ligament insertion site.