Low Femoral Tunnel Widening Incidence Rate After ACL Reconstruction Using Patellar Tendon Graft with Press-Fit Fixation

Background Femoral tunnel widening after ACL reconstruction is a common phenomenon. We hypothesized that using a patellar tendon graft with a press-ft fxation technique without any fxation device reduces the incidence of femoral tunnel widening. Methods This study was conducted on 467 patients with ACL surgery between 2003 and 2015. Two hundred and nineteen of them had an ACL surgery with patellar tendon (PT) graft, and two hundred and forty-eight of them with hamstring tendon (HS). Exclusion criteria were history of previous ACL reconstruction of either knee, multiple ligament injury, or evidence of osteoarthritis on radiographs. The femoral tunnels were measured on the anteroposterior (ap) and lateral radiographs 6 months after the operation. Two independent orthopedic surgeons measured all radiographs twice and recorded the tunnel widenings. We hypothesized that using an implant-free press-ft technique with PT graft can reduce the femoral tunnel widening incidence rate. Results The mean incidence rate of the tunnel widening in the HS group was, on the AP and the lateral femoral views, 88% (n=217) and 83% (n=205), while in the PT group, 17% (n=37) and 2% (n=4), respectively. There was a signifcant difference both on AP and lateral radiographs (HS vs. PT: fem. AP: 89% vs. 17% p<0.001; HS vs. PT: fem. lat: 84% vs. 2% p<0.001). Conclusion The femoral tunnel widening incidence rate during an ACL reconstruction is signifcantly less when using PT tendon with femoral press-ft fxation than when using HT tendon with suspensory fxation method.