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The Relationship Between Tunnel Placement and Clinical Results After Anterior Cruciate Ligament Reconstruction

Department of Orthopaedic Surgery, Naval Medical Center, Oakland, California

Peter F. Sharkey, LCDR, MC, USNR

Department of Orthopaedic Surgery, Naval Medical Center, Oakland, California

A. Herbert Alexander, CAPT, MC, USN

Department of Orthopaedic Surgery, Naval Medical Center, Oakland, California

James D. Bruckner, LCDR, MC, USNR

Department of Orthopaedic Surgery, Naval Medical Center, Oakland, California

E. Bruce Bynum, CDR, MC, USNR

Department of Orthopaedic Surgery, Naval Medical Center, Oakland, California

To correlate clinical results after anterior cruciate liga ment reconstruction with tunnel placement measured radiographically, we prospectively studied 128 patients who had arthroscopically assisted bone-patellar ten don-bone reconstructions. Patients with bilateral ante rior cruciate ligament reconstructions, other significant knee ligament injuries, or those undergoing chondro plasty or meniscal repairs were excluded, leaving 42 patients. The relationship between radiographic tunnel position and clinical results was determined using the Lysholm score, KT-1000 arthrometer testing, the Teg ner activity level, and the pivot shift and Lachman tests. Clinical results correlated positively with posterior fem oral tunnel placement on lateral radiographs and neg atively with excessive anterior tibial tunnel placement. Specifically, when femoral tunnels were placed at least 60% posterior along Blumensaat's line and tibial tun nels were at least 20% posterior along the tibial pla teau, 69% of patients had good or excellent Lysholm scores and 79% had KT-1000 arthrometer maximum manual side-to-side differences of 3 mm or less. When the above criteria were not met, 50% of patients had good or excellent Lysholm scores and 22% had KT- 1000 arthrometer maximum manual side-to-side differ ences of 3 mm or less. This close correlation indicates that satisfactory radiographic tunnel position influences outcome after anterior cruciate ligament reconstruc tion.

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