# Neglected errors in ligament reconstruction surgery may increase graft-tunnel mismatch: A biomechanical study

## TL;DR

This study shows that errors in surgical tools and methods during ligament reconstruction can cause graft-tunnel mismatches, especially at the tibial end.

## Contribution

The study introduces a new measuring gauge that reduces graft-diameter measurement errors in ligament reconstruction surgery.

## Key findings

- Traditional surgical instruments caused greater graft-tunnel mismatches compared to custom instruments.
- Graft-tunnel mismatch was more pronounced at the tibial end than at the femoral end.
- A new measuring gauge improved graft diameter accuracy and reduced mismatch.

## Abstract

Tunnel widening is a frequent problem following arthroscopic ligament reconstruction surgery that may primarily arise from a graft-tunnel mismatch caused by errors in surgical instruments and methods. The present study aimed to observe the influence of current surgical instruments and methods on graft-tunnel matching. We established an in vitro model using porcine Achilles tendons and tibias, and compared traditional surgical instruments (control group) with custom instruments (experimental group). Graft measurements, bone-tunnel creation, and measurements of the maximum pullout force of the graft from the bone tunnel were performed. Results indicated that the measuring gauge developed by our research group (capable of accurate measurement of graft diameters) may mitigate errors arising from graft-diameter measurement using traditional measuring cylinders. Therefore, errors caused by current surgical instruments and surgical methods led to an increase in graft-tunnel mismatches. The degree of mismatch was greater at the tibial end than at the femoral end.