Intra-articular migration of the tibial bone plug during anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: a case series
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253427Keywords:
BPTB grafts, ACL reconstruction, Tibial bone plug, Migration, Screw divergenceAbstract
Bone-patellar tendon-bone (BPTB) autografts are a preferred choice for anterior cruciate ligament (ACL) reconstruction due to their potential for reliable bone-to-bone healing. However, technical errors can lead to significant complications. This report presents a series of three cases where the tibial bone plug of a BPTB autograft migrated into the intra-articular space. Postoperative analysis identified that proximal displacement of femoral bone plug, divergence of the interference screw during femoral screw fixation was the primary cause. This led to proximal migration of the graft, increase of tension, and subsequent displacement of the tibial bone plug. These cases underscore the critical importance of meticulous surgical technique, particularly in ensuring accurate screw placement to prevent graft migration.
Metrics
References
Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-Year Comparison of Anterior Cruciate Ligament Reconstructions with Hamstring Tendon and Patellar Tendon Autograft: A Controlled, Prospective Trial. American J Sports Med. 2007;35(4):564-74. DOI: https://doi.org/10.1177/0363546506296042
Miller MD. Editorial Commentary: Anterior Cruciate Ligament Graft Tunnel Mismatch: The Long and Short of It. Arthroscopy. 2018;34(8):2444-5. DOI: https://doi.org/10.1016/j.arthro.2018.05.020
Olszewski AD, Miller MD, Ritchie JR. Ideal tibial tunnel length for endoscopic anterior cruciate ligament reconstruction. Arthroscopy. 1998;14(1):9-14. DOI: https://doi.org/10.1016/S0749-8063(98)70114-8
Su CA, Knapik DM, Trivedi NN, Megerian MF, Salata MJ, Voos JE. Femoral interference screw fixation in ACL reconstruction using bone-patellar tendon-bone grafts. JBJS Reviews. 2020;8(1):66. DOI: https://doi.org/10.2106/JBJS.RVW.19.00066
Brown JA, Brophy RH, Franco J, Marquand A, Solomon TC, Watanabe D. Avoiding allograft length mismatch during anterior cruciate ligament reconstruction: patient height as an indicator of appropriate graft length. Am J Sports Med. 2007;35(6):986-9. DOI: https://doi.org/10.1177/0363546506298584
Verma N, Noerdlinger MA, Hallab N, Bush-Joseph CA, Bach BR Jr. Effects of graft rotation on initial biomechanical failure characteristics of bone-patellar tendon-bone constructs. Am J Sports Med. 2003;31(5):708-13. DOI: https://doi.org/10.1177/03635465030310051201
Allen CR, Giffin JR, Harner CD. Revision anterior cruciate ligament reconstruction. Orthop Clin North Am. 2003;34(1):79-98. DOI: https://doi.org/10.1016/S0030-5898(02)00066-4
Agarwal S, Sa D, Peterson DC, Parmar D, Simunovic N, Ogilvie R, Musahl V, Ayeni OR. Can Preoperative Magnetic Resonance Imaging Predict Intraoperative Autograft Size for Anterior Cruciate Ligament Reconstruction. A Systematic Review. J Knee Surg. 2019;32(7):649-58. DOI: https://doi.org/10.1055/s-0038-1666830
Rodin D, Levy IM. The use of intraoperative fluoroscopy to reduce femoral interference screw divergence during endoscopic anterior cruciate ligament reconstruction. Arthroscopy. 2003;19(3):314-7. DOI: https://doi.org/10.1053/jars.2003.50051
Taylor DE, Dervin GF, Keene GC. Femoral bone plug recession in endoscopic anterior cruciate ligament reconstruction. Arthroscopy. 1996;12(4):513-5. DOI: https://doi.org/10.1016/S0749-8063(96)90054-7
Ko D, Kim HJ, Oh SH, Kim BJ, Kim SJ. How to Avoid Graft-Tunnel Length Mismatch in Modified Transtibial Technique for Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft. Clin Orthop Surg. 2018;10(4):407-12. DOI: https://doi.org/10.4055/cios.2018.10.4.407