The Effect of Tibial Tunnel Drilling Technique on Retained Intra-Articular Bone Debris Following Anterior Cruciate Ligament Reconstruction

• Published in: Arthroscopy, Sports Medicine, and Rehabilitation Vol. 5; no. 2; pp. e337 - e343
• Main Authors: Batty, Lachlan, Huntington, Lachlan S., Chung, Timothy, Spiers, Libby, Tulloch, Scott, Webster, Kate E., Tran, Phong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023; Elsevier
• Subjects: Original
• ISSN: 2666-061X; 2666-061X
• DOI: 10.1016/j.asmr.2022.12.002

To assess the effect of tibial tunnel drilling technique (retro-drilled bone socket vs full tibial tunnel) on the presence and grade of postoperative, intra-articular bone debris following primary hamstring anterior cruciate ligament (ACL) reconstruction. This was a retrospective cohort study of primary hamstring autograft ACL reconstructions performed by 2 surgeons. Two blinded independent reviewers assessed the presence and length of retained intra-articular bone debris on the immediate postoperative lateral radiograph. Debris was graded according to a predefined 5-point ordinal grading system: grade 0 (no debris) to IV (severe debris). Results were analyzed according to the type of tibial tunnel; retro-drilled socket or full tibial tunnel using Kappa statistics and the Mann–Whitney U test. Sixty-five patients undergoing primary hamstring ACL were included (39 tibial socket: 26 full tibial tunnel). Bone debris was observed among the tibial socket technique in 29 of 39 instances (74.3%), compared with 14 of 26 (53.8%) instances for the full tibial tunnel technique (P = .09). Where there was measurable debris present, the tibial socket group had a mean length of bone debris of 13.7 ± 6.2 mm as compared with the full tibial tunnel, 10.0 ± 4.7 mm (P = .165). There were significant differences in bone debris gradings between the 2 treatment groups, with tibial sockets having an overall greater grade (P = .04). A difference in the presence of, or length of, retained bone debris on the postoperative lateral radiograph was not demonstrated between the retro-drilled bone socket and full tibial tunnel techniques. However, when bone debris was present, greater grades of debris were seen in the retro-drilled socket group. III, retrospective, comparative study.