Comparison of Clinical Outcomes between Different Femoral Tunnel Positions after Anterior Cruciate Ligament Reconstruction Surgery

Background: It has been shown that the proper placement of ACL graft during the ACL reconstruction surgery significantly improves the clinical outcomes. This study investigated whether a change in the femoral tunnel position in both axial and coronal planes can significantly alter the postoperative functional and clinical outcomes of the patients. Methods: This comparative, retrospective, single-center study was performed on 44 patients undergone single-bundle anterior cruciate ligament reconstruction (ACLR). Radiographic assessments were done to evaluate the tunnel position in coronal and axial planes. Patients were classified into 4 groups based on radiographic data. The time interval between surgery and last visit averaged 23.6 ± 2.2 months (18-30 mos.). Lysholm knee score and Cincinnati score were completed for all of the patients. Furthermore, the Lachman, anterior drawer and pivot-shift tests were performed. Results: Of the 44 patients included in the study, 9 patients (20.4%) were classified as the low-anterior group, 17(38.6%) were classified as the low-posterior group and 18(40.9%) were classified as the high-posterior group. None of the patients were included in high-anterior group. A greater mean Lysholm score (96±3) in low-posterior group was the only significant difference between the three groups (P 0.001). Conclusion: Findings of the current study demonstrated that low-posterior placement of the ACL graft through the intercondylar notch, based on both antero-posterior (AP) and tunnel-view x-rays, is associated with better clinical outcomes in short-term compared to the routine tunnel placements.