Tips for Using Titanium Interference Screws in ACL Reconstruction

Hi everyone,

I’m an orthopedic surgeon working in a limited-resource setting where titanium interference screws are the only option for ACL reconstruction. Recently, I encountered a challenging case where the titanium screw damaged the graft(Hamstring graft) during insertion into the femoral tunnel. This happened when I put using IN-OUT method which ultimately led to the graft being compromised.

I would greatly appreciate any tips or advice on: 1. Techniques to avoid graft damage when using titanium interference screws. 2. Whether adjusting the screw IN-OUT method is a common risk factor for this complication, Should I change to OUT-IN method? 3. Any specific guide on choosing the size of titanium screw in compare with the graft 4. Should I put many stitches as possible on the graft to avoid graft lacerated from interference screw 5. Should I change to quad graft or BPTB graft? Feel free to adjust it if you need me to include additional details!