The Effect of Femoral Tunnel Starting Position on Tunnel Length in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study

Variations in the three‐dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction

“…The surgeons in this study all used a traditional transtibial technique and were not intending to implement the modifications required to produce more anatomical graft placement with the transtibial technique. 26,28 However, as discussed in Kopf et al, 22 it is important to note that the nonanatomic tunnel positions drilled using conventional transtibial guidelines in this study were consistent among the multiple surgeons from different institutions with successful results. The fact that all patients were considered to have a clinically successful reconstruction, even with nonanatomic tunnel positions, raises important questions about the current clinical evaluation protocols.…”

“…[7][8][9] Consequently, anatomic placement of the ACL graft has received increasing attention as a potential critical factor in the future success of the procedure. Although there is not currently a consensus on the optimal surgical technique to achieve anatomic graft placement, most authors support modifications to the transtibial technique 26,28 or independent drilling of the tibial and femoral tunnels 24,25,27,29 in order to more accurately place the graft in the center of the native ACL footprint, with particular focus on the femoral graft position. However, the results in this study suggest that the largest offset from the normal position occurs in the posterior placement of the tibial footprint and tibial placement appears to be biggest significant factor in the vertical orientation of the graft for this population.…”

“…[19][20][21][22][23] Taken together, these findings have generated interest in surgical recommendations, both transtibial and independent femoral tunnel placement techniques, that emphasize placement of the graft in the center of the native ligament footprints. [24][25][26][27][28][29] Given that significant anatomic variation exists between patients, 30 there is a clear need to understand the interaction between ACL footprint position and orientation for the evaluation of anatomic graft placement on a patient-specific basis as more surgeons begin to adopt anatomic ''footprint'' techniques.…”

Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

“…In an attempt to improve graft placement, Golish et al suggested centering the femoral tunnel into the ACL footprints via TT technique with a far medial entry in tibia [19]. Controversially, several authors concluded that attempting an anatomical femoral tunnel positioning through the TT technique would require a starting point too close to the tibial joint line, resulting in a relatively short and medial tibial tunnel and a tunnel length-graft length mismatch.…”

Reply to: Comments on Alentorn-Geli et al.: Anteromedial portal (AMP) versus transtibial (TT) drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

“…Studies referenced by Dr. Kini to support his first concern reported a tibial tunnel orientation of 60-70°in the coronal plane, but these angles were considered from the horizontal line, whereas the 20°in our study was considered from the vertical line [4,5,7]. Other authors perform the tibial tunnel with a mean angulation of 60.6°, ranging up to 74.2° [9].…”