![]() ![]() Because of its advantages in ligament healing and proprioception, we preferred remnant-preserving ACL reconstruction with internal sutures between the remnant and reconstructed graft. After assessing the amount of remaining fiber and the tension of the injured ACL, the surgeon chose to perform an ACL reconstruction. We hypothesized that ACL reconstruction using an allo-Achilles graft with the suggested surgical tips would lead to less TW.Īll patients underwent single-bundle ACL reconstruction by a transtibial technique with careful targeting of the femoral insertion of the native ACL. This study suggests surgical techniques to prevent TW by using an allo-Achilles tendon graft and to evaluate TW after ACL reconstruction with these techniques. 5 It has been reported that these surgical procedures can effectively reduce the extent of TW however, there is still controversy regarding the most effective method of preventing TW. Many recent studies have tried to prevent TW by modifying the surgical techniques used strategies include the use of a bone plug application with press-fit, 17, 18 bone impaction using a dilator, 19 proper tunnel positioning, 8 and a periosteal envelope. 10 The biological factors proposed include an antigenic immune response, 11 a toxic effect, 1 a nonspecific inflammatory response, 12 and cellular necrosis from drilling and graft remodeling, 13, 14, 15 and the mechanical factors proposed include local stress deprivation of the tunnel wall, 15 graft-tunnel motion, 12 aggressive rehabilitation, 16 and increased graft forces due to improper graft placement. The etiology of TW is still unclear as both mechanical and biological factors have been suggested to play roles. 2, 3, 4, 5, 6, 7, 8 The correlation between TW and the clinical outcomes of ACL reconstruction remains unclear however, many researchers have investigated the causes of TW and methods of preventing it because TW can be a factor in graft failure after ACL reconstruction 9 and makes revision ACL reconstruction difficult. After the first description of tunnel widening (TW) following anterior cruciate ligament (ACL) reconstruction in the 1990s, 1 the condition has been reported in many other studies. ![]()
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