Grafts placed too anteriorly on the femur are reportedly a common cause of failure in anterior cruciate ligament reconstruction.
Some studies suggest more anatomic femoral tunnel placement improves kinematics. The ability of the transtibial technique
and a tibial tunnel-independent technique (placed transfemorally outside-in) to place the guide pin near the center of the
femoral attachment of the anterior cruciate ligament was compared in 12 cadavers. After arthroscopic placement of the guide
pins, the femur was dissected and the three-dimensional geometry of the femur, anterior cruciate ligament footprint, and positions
of each guide pin were measured. The transtibial guide-pin placement was 7.9 ± 2.2 mm from the center of the footprint (near
its anterior border), whereas the independent technique positioned the guide pin 1.9 ± 1.0 mm from the center. The center
of the footprint was within 2 mm of an anteroposterior line through the most posterior border of the femoral cartilage in
the notch and a proximodistal line through the proximal margin of the cartilage at the capsular reflection. More accurate
placement of the femoral tunnel might reduce the incidence of graft failure and might reduce long-term degeneration observed
after reconstruction although both would require clinical confirmation.
The institution of the authors has received funding from Arthrex.
Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation
and that all investigations were conducted in conformity with ethical principles of research.