A simple way to deal with an inadvertently cut suture while inserting the screw in the tibial tunnel during ACL reconstruction

INTRODUCTION: There are many complications that can occur during or after ACL reconstruction, including a suture inadvertently cut by the screw threads while inserting the interference screw in the tibial tunnel. No fixes for this small but annoying problem have been proposed to date in the literature, and herein we propose a simple way to deal with this situation by bringing the tibial side of the ACL graft through the anterolateral portal and re-suturing with a stronger suture material. CASE PRESENTATION: A 48-year-old Thai female was undergoing an ACL reconstruction with a hamstring graft following a standard technique when the holding suture and distal part of the ACL graft were accidentally cut by the screw. Rather than redoing the graft from the beginning, we did a workaround by bringing the tibial end of the graft through the AL portal and re-suturing. DISCUSSION: In ACL graft fixation, when inserting the interference screw into the tibial tunnel there is a risk of cutting the holding suture with the screw. When this happened in our situation, we decided to attempt to redo the suture by first taking the graft out through the AL portal and then re-suturing with a stronger suture material. CONCLUSION: If inadvertently cutting the holding suture while inserting the screw in the tibial tunnel during ACL reconstruction occurs, the surgeon can use the simple solution we applied in this case to solve this problem or to avoid having to redo the entire procedure.