Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. A common belief of having ≥20mm of grafts within the femoral tunnel is backed mostly by hearsay rather than scientific proof.

We examined clinico-radiological outcomes in patients with intra-femoral tunnel graft lengths <20 and ≥20mm. Primary outcomes were knee scores at 1-year. Secondarily, graft revascularization was compared using magnetic resonance imaging (MRI). We hypothesized that outcomes would be independent of intra-femoral tunnel graft lengths.

This prospective, single-surgeon, cohort study was conducted at a tertiary care teaching centre between 2015–2018 after obtaining ethical clearances and consents. Eligible arthroscopic ACL reconstruction patients were sequentially divided into 2 groups based on the intra-femoral tunnel graft lengths (A: < 20 mm, n = 27; and B: ≥ 20 mm, n = 25). Exclusions were made for those > 45 years of age, with chondral and/or multi-ligamentous injuries and with systemic pathologies. All patients were postoperatively examined and scored (Lysholm and modified Cincinnati scores) at 3, 6 and 12 months. Graft vascularity was assessed by signal-to-noise quotient ratio (SNQR) using MRI. Statistical significance was set at p<0.05.

Age and sex-matched patients of both groups were followed to 1 year (1 dropout in each). Mean femoral and tibial tunnel diameters (P =0.225 and 0.595) were comparable. Groups A (<20mm) and B (≥20mm) had 27 and 25 patients respectively. At 3 months, 2 group A patients and 1 group B patient had grade 1 Lachman (increased at 12 months to 4 and 3 patients respectively). Pivot shift was negative in all patients. Lysholm scores at 3 and 6 months were comparable (P3= 0.195 and P6= 0.133). At 1 year both groups showed comparable Cincinnati scores. Mean ROM was satisfactory (≥130 degrees) in all but 2 patients of each group (125–130 degrees). MRI scans at 3 months and 1 year observed anatomical tunnels in all without any complications. Femoral tunnel signals in both groups showed a fall from 3–12 months indicating onset of maturation of graft at femoral tunnel.

Our hypothesis, clinical and radiological outcomes would be independent of intra-tunnel graft lengths on the femoral aspect, did therefore prove correct. Intra-femoral tunnel graft lengths of <20 mm did not compromise early clinical and functional outcomes of ACL reconstructions. There seems to be no minimum length of graft within the tunnel below which suboptimal results should be expected.

To prospectively evaluate patient outcome in terms of stability, function and satisfaction following an arthroscopic anterior Bankart repair in order to identify patient characteristics, surgical technique or instrumentation linked to poor outcomes. These findings can then be used to refine selection criteria such that patient benefit from the shoulder instability repair is maximised.

Between April 2002 and June 2004 thirty-seven arthroscopic anterior Bankart lesion repairs were performed by a single orthopaedic surgeon. Data on concomitant shoulder pathology, surgical technique utilised and instrumentation used was recorded for each patient. Reoccurrence rate, patient satisfaction and range of motion were evaluated pre-operatively, and then six weeks, three months, six months, twelve months and twenty-four months post-operatively.

Four of thirty-seven patients (10.8%) experienced at least one post-operative reoccurrence defined as a subluxation or dislocation. There was a statistically significant association between the presence of an inverted pear-shaped glenoid and increased incidence of reoccurrence (p < 0.05). Patients’ satisfaction with their shoulders increased significantly from 43% pre-operatively to 71% at the two-year follow-up, as measured by the Western Ontario Shoulder Instability (WOSI) scale. There were no significant differences in range of motion between the patients’ surgically repaired and unaffected shoulders.

An arthroscopic repair of an anterior Bankart lesion can yield good-to-excellent results for the majority of patients with respect to stability, function and satisfaction. The presence an inverted pear-shaped glenoid is mostly strongly correlated with an increased incidence of reoccurrence. Patients should be screened pre-operatively to identify this bony abnormality such that it can be addressed appropriately during surgery.