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The Effect of Graft-Tunnel Diameter Disparity on Intraosseous Healing of the Flexor Tendon Graft in Anterior Cruciate Ligament Reconstruction

Shuji Yamazaki, MD, Kazunori Yasuda, MD, PhD^,, Fumihisa Tomita, MD, Akio Minami, MD, PhD and Harukazu Tohyama, MD, PhD

Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan, Department of Medical Bioengineering and Sports Medicine, Hokkaido University School of Medicine, Sapporo, Japan

Presented at the 25th annual meeting of the AOSSM, Traverse City, Michigan, June 1999.

Address correspondence and reprint requests to Kazunori Yasuda, MD, PhD, Department of Medical Bioengineering and Sports Medicine, Hokkaido University School of Medicine, Kita-15 Nishi-7, Sapporo, 060-8638, Japan

Background: Graft-to-tunnel healing is a significant factor in anterior cruciate ligament reconstruction, but there have been few studies on the effect of graft-tunnel diameter disparity on intraosseous healing of the flexor tendon graft.

Hypothesis: Graft-tunnel diameter disparity of 2 mm has no effect on the pull-out strength of the graft from the bone tunnel.

Study Design: Controlled laboratory study.

Methods: Forty-two beagle dogs were divided into three groups. In each animal, reconstruction was performed in the left knee by using a 4-mm diameter autogenous flexor tendon for groups 1 and 2 and by using a 4-mm wide bone-patellar tendon-bone graft in group 3. A 4-mm diameter tunnel was drilled in the tibia of groups 1 and 3 and a 6-mm diameter tunnel, in group 2. In each group, seven animals were sacrificed at 3 and 6 weeks.

Results: The perpendicular fibers connecting the graft to the bone were generated in groups 1 and 2, and the number appeared to be higher in group 2, where the space was greater. There was no significant difference in the ultimate failure load between groups 1 and 2 at each period.

Conclusion: Graft-tunnel diameter disparity of up to 2 mm may not adversely affect intraosseous healing of the flexor tendon graft.

Clinical Relevance: Surgeons need not be overly concerned about minor graft-tunnel diameter disparities.

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