Those with graft length of 25 mm or more inside the femoral tunnel were not at lower risk of graft tear in soccer players submitted to anatomical anterior cruciate ligament reconstruction

INTRODUCTION/OBJECTIVES: Anatomical anterior cruciate ligament (ACL) reconstruction can lead to shorter femoral tunnels, which can have decreased load capacity to failure. How much graft needs to be inside the femoral tunnel to allow proper graft integration and protect against graft tears remains unclear. The primary aim was to compare the rate of graft tear after ACL reconstruction in high-level soccer players between those with 25 mm or more of length of graft within the femoral tunnel (vs 20-24 mm). METHODS: A total of 63 soccer players (mean age 22 ± 5.2 years, male-to-female ratio of 6:1) with a Tegner score ≥9 who underwent anatomical ACL reconstruction using the arthroscopic antero-medial technique with hamstrings autograft between January 2021 and May 2024 were included. The primary outcomes were the incidence of graft tear and the length of graft within the femoral tunnel. The secondary outcomes included graft diameter and femoral tunnel length. Patients were followed for 24 months to evaluate new knee injuries, graft tear, and return-to-sports (RTS) rates. RTS was defined as rejoining previous competitive sports. RESULTS: Seven athletes (11.1%) suffered a graft tear. The overall RTS rate was 71% (45/63, secondary outcome), while the new knee injury rate was 19.1% (12/63) (secondary outcome). Graft length within the femoral tunnel was 24.3 ± 2.3 mm (20-28 mm) and was not significantly different between those with and without graft tear (23.8 mm vs 24.4 mm, p = 0.08). Similarly, total femoral tunnel length (p = 0.47), concomitant knee injuries (p = 0.32) and graft diameter (p = 0.67) were not statistically significantly different between those with and without graft tear. CONCLUSIONS: The ACL graft length inside the femoral tunnel was not different between those with and without graft tear in a limited sample of 63 high-level soccer players undergoing anatomical ACL reconstruction with hamstrings autograft and followed for 2 years. Aiming for 25 mm or more of graft inside the femoral tunnel does not seem to provide an advantage in reducing the risk of graft tears as compared to 20-24 mm. LEVEL OF EVIDENCE: III.