A recent biomechanical study has introduced a promising new technique in anterior cruciate ligament (ACL) reconstruction that could improve surgical precision and patient outcomes. The research, titled “ACL Graft Compression: A Method to Allow Reduced Tunnel Sizes in ACL Reconstruction,” explores the use of a compressed graft to allow for smaller bone tunnels during surgery without compromising the new ligament’s integrity.
The Challenge of ACL Reconstruction
ACL reconstruction is a common procedure for treating torn or ruptured ligaments, but it presents several challenges. Traditionally, surgeons must drill bone tunnels wide enough to accommodate the thickest part of the graft, often leading to graft-tunnel mismatch and bone loss. This can complicate the initial fixation of the graft and may make future revision surgeries more difficult.
The New Graft Compression Technique
This study investigated a method of using graft compression to downsize the graft’s diameter before insertion. The researchers conducted a series of biomechanical tests to determine if this technique would negatively affect the graft’s strength or stiffness.
The findings were highly encouraging:
- Comparable Strength: Compressed grafts were found to have similar strength and stiffness to their uncompressed counterparts, suggesting that the compression process doesn’t weaken the new ligament.
- Reduced Tunnel Size: By compressing the graft, surgeons can create smaller, more precise bone tunnels. This preserves valuable bone stock and can improve the accuracy of graft placement, bringing it closer to the native ACL’s natural position.
- Increased Stability: The study also suggests that a compressed graft may expand inside the bone tunnel after surgery, effectively creating a tighter fit. This could help to stabilise the graft and block synovial fluid from entering the tunnels, a factor thought to contribute to tunnel widening and graft failure.
The authors concluded that graft compression is a viable method that offers several key advantages for ACL reconstruction, including reduced bone loss and enhanced surgical accuracy. These findings are a significant step forward in refining surgical techniques to provide better long-term results for patients.
Professor Wilson’s Comments
“This is a lovely paper that highlights some of the important work carried out using my Graft Compression System, which I co-patented with Arthrex.
This system is now universally available and is used extensively around the world in both ACL and PCL reconstruction. It enables surgeons to compress grafts so that they are uniform in size throughout, eliminating mismatch between graft and tunnel.
More importantly, by compressing the tissue, surgeons can drill smaller tunnels for a smaller, compacted graft that then expands to fill the tunnel perfectly. This ensures optimal graft-to-bone contact, improving healing, fixation, and long-term stability.
The foundational research for this innovation was carried out in the biomechanics laboratory at Imperial College London in collaboration with Professor Andrew Amis and Mr Breck Lord, a close friend, who kindly dedicated part of his PhD to this concept. His research explored both the Graft Compression System and other novel ideas I was developing at the time, including the TriLink graft.
I’m extremely proud of this achievement — a true breakthrough in modern sports medicine — now adopted in leading orthopaedic centres worldwide, and a key part of every ACL and PCL case I perform.”
For an in-depth look at the full data and a comprehensive breakdown of the methodology, refer to the complete research paper:
ACL Graft Compression: A Method to Allow Reduced Tunnel Sizes in ACL Reconstruction
Sources used in report overview:
- https://pubmed.ncbi.nlm.nih.gov/29623378/
- https://www.ruh.nhs.uk/patients/patient_information/PHY059_Post_Operative_Advice_after_ACL_Reconstruction.pdf
- https://www.drjensbuelow.com.au/knee-specialist-perth/biological-and-biomechanical-factors-for-acl-reconstruction-2/
