The Tibial Tug Test: An Intraoperative Test to Assess Tibial Fixation During Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament (ACL) is commonly injured, especially in athletes performing twisting and pivoting motions. ACL reconstruction is a standard procedure; however, there is no way to intraoperatively assess one of the causes of failure: the lack of adequate graft fixation on the tibial side. Different fixation devices can be used to ensure fixation, but there is as yet no consensus on which is the most effective. Moreover, there is no reliable way to assess their strength in the intraoperative setting. The tibial tug test is meant to be an important resource to help avoid fixation failure by evaluating the tibial fixation device intraoperatively and giving the surgeon the opportunity to revise the tibial fixation if deemed inadequate. The aim of this article is to describe an empirical and simple test that can demonstrate to the surgeon adequate tibial fixation during ACL reconstruction surgery.