# Simple Technique to Address Graft-Tunnel Mismatch in Bone−Patellar Tendon−Bone Anterior Cruciate Ligament Reconstruction

## TL;DR

This paper introduces a simple surgical technique to fix graft-tunnel mismatch during ACL reconstruction using a bone-patellar tendon-bone graft.

## Contribution

The novel contribution is a reproducible whipstitch backup fixation technique to address graft-tunnel mismatch without adjusting femoral fixation.

## Key findings

- Graft-tunnel mismatch can be as high as 20% in ACL reconstruction.
- The proposed whipstitch technique provides reliable graft tension after trimming the tibial bone block.
- The technique does not require adjustment of femoral fixation.

## Abstract

Graft-tunnel mismatch during anterior cruciate ligament reconstruction using bone−patellar tendon−bone autograft is a significant problem, and it is imperative that the orthopaedic surgeon knows how to address this intraoperatively. Graft-tunnel mismatch has been reported to be as high as 20% during anterior cruciate ligament reconstruction with bone−patellar tendon−bone autograft. We present a technique that is easily reproducible using a simple whipstitch for backup fixation after trimming the tibial-sided bone block that gives reliable tension on the graft without necessitating adjustment of femoral fixation.