Effects of graft rotation on initial biomechanical failure characteristics of bone-patellar tendon-bone constructs

Graft-tunnel mismatch is a potential problem during single-incision technique for anterior cruciate ligament reconstruction with the central third of the patellar tendon. Mismatch is present when the graft is too long to fit appropriately in the tunnels that have been created. Graft rotation is one method for addressing this problem.

To determine the results of graft rotation up to 540 degrees on initial graft biomechanical properties and graft length.

Controlled laboratory study.

Forty porcine bone-patellar tendon-bone constructs were divided into four groups and constructs were rotated to 0 degrees, 90 degrees, 180 degrees, and 540 degrees, respectively, for each group. Biomechanical testing to failure was performed with the constructs under tension at an elongation rate of 5 cm/sec. Lengths were measured after a 1-kg load was applied to the grafts.

No statistical difference in ultimate failure strength was encountered between any of the groups (P = 0.915). The grafts that were twisted to 540 degrees shortened an average of 5.41 mm, which represented an average shortening of 10% of the initial tendon length.

Graft rotation up to 540 degrees does not result in loss of initial graft strength, and may be a solution for graft-tunnel mismatch.