Avoiding pitfalls in tibial bone plug fixation in anterior cruciate ligament reconstruction

Performing arthroscopic anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone autograft normally includes placing sutures in the femoral bone plug to be able to pull the graft through the joint, and in the tibial bone plug to be able to apply tension to the graft as you insert the distal interference screw. We have used one No. 5 Ethibond suture (Ethicon, Somerville, NJ) for the femoral bone plug, and normally place two similar sutures into the tibial bone plug. This is to reduce the risk of loosing tension if one of the sutures is cut while inserting the tibial fixation screw. This article suggests a solution to the problems that will arise in cases of accidentally cutting both of the sutures in the tibial bone plug.