Purpose
The purposes of this study were to measure the anterior edge of the tibial tunnel
after anatomic anterior cruciate ligament (ACL) reconstruction on lateral radiographs
and to determine whether the difference in tibial tunnel placement affects postoperative
outcomes.
Methods
For 60 patients who underwent anatomic double-bundle ACL reconstruction with semitendinosus
tendon, we evaluated the side-to-side difference in anterior tibial translation on
stress radiographs, as well as rotational stability by the pivot-shift test, 2 years
after surgery. Loss of extension (LOE) was evaluated on lateral radiographs of both
knees in full extension, and graft integrity was assessed during second-look arthroscopy
1 to 2 years after surgery. On true lateral radiographs, we measured the anterior
placement percentage of the tibial tunnel using the method described by Amis and Jakob.
The cutoff value was set at 25% of the mean value of the anterior edge of the ACL
that Amis and Jakob reported, and patients were divided into 2 groups (27 in the anterior
group and 33 in the posterior group). Postoperative clinical results were compared
between the groups.
Results
The mean anterior placement percentage was 26.0% ± 4.1%. The postoperative mean side-to-side
difference was 1.4 ± 2.7 mm for the anterior group and 3.0 ± 2.7 mm for the posterior
group, a significant difference (P < .05). The positive ratio of the pivot-shift test was not significantly different
between groups (P > .05). Mean LOE in the anterior and posterior groups was 0.9° ± 3.0° and −0.8° ±
4.0°, respectively; the difference was not significant (P > .05). Five of 27 knees in the anterior group and 5 of 33 knees in the posterior
group had superficial graft laceration or elongation, which was not significantly
different (P > .05).
Conclusions
Anterior placement of the tibial tunnel in anatomic double-bundle ACL reconstruction
leads to better anterior knee stability than posterior placement does. Anterior tibial
tunnel placement inside the footprint did not increase the incidence of LOE and graft
failure.
Level of Evidence
Level IV, therapeutic case series.
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Article info
Publication history
Published online: April 08, 2013
Accepted:
February 6,
2013
Received:
April 9,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
