Radiological assessment of femoral and tibial tunnel placement in arthroscopic ACL reconstruction using hamstring tendon graft

Abstract

Background: Proper and accurate placement of tibial and femoral tunnels has a significant impact on anterior cruciate ligament (ACLR) reconstruction outcomes. After ACLR, postoperative radiographs give us a precise and valid way to evaluate anatomical tunnel positioning. Aim of this study is to analyze the radiographic position of tibial and femoral tunnels in patients with anatomic landmarks who have undergone arthroscopic ACLR. This prospective cohort analysis included patients who underwent arthroscopic ACLR between January 2018 and May 2019.Materials and Methods: It is a prospective study conducted on 40 patients who has undergone arthroscopic ACLR, postoperative radiographs were assessed. Femoral and tibial tunnel positions on sagittal and coronal radiographic views, graft impingement, and femoral roof angle were measured. Radiological parameters were summarized as mean ± standard deviation, inter-quartile range and proportions as applicable.Results: The position of the tibial tunnel from the anterior edge of the tibia is found at an average of 44.98% ± 8.77% later. The femoral tunnel was located 36.4% ± 4.8% before the posterior femoral cortex along the axis of the Blumensaat’s. Radiographic impingement was found in 32.5% of the patients. The roof angle averaged 39.8° with interquartile range of 4°. The position of the tibial tunnel was found at an average of 39.3% ± 4.19% from the medial edge of the tibial plateau. The coronal tibial tunnel angle averaged 58.7° ± 8.7°. The average femoral tunnel coronal angle was 39.8 ° ± 3.26 °.Conclusion: Femoral and tibial tunnel placements were well associated with anatomical landmarks with the exception of radiographic impingement in 32.5% of patients.