title: A reproducible landmark for the tibial tunnel origin in anterior cruciate ligament reconstruction: avoiding a vertical graft in the coronal plane.
abstract: Improper tunnel placement during anterior cruciate ligament reconstruction may result in residual instability. Proper femoral tunnel orientation relies on tibial tunnel placement with a transtibial technique. Our recommended technique is to use the junction of the anterior border of the superficial medial collateral ligament and the superior border of the gracilis tendon as a reproducible anatomic landmark for the tibial tunnel. In a cadaveric model the mean angle for the tibial tunnel was 65.7 degrees +/- 5.5 degrees in the coronal plane and 75 degrees +/- 7.2 degrees in the sagittal plane. By use of the clock-face method, the mean angle for the femoral tunnel was 44.9 degrees +/- 13 degrees , or approximately the 10:30 position (for a right knee) or 1:30 position (for a left knee).
authors.affiliation: Metro Orthopedics and Sports Therapy, Silver Spring, Maryland 20910, USA. csraffo@yahoo.com
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Raffo
authors.forename: Peter
authors.initials: P
authors.lastname: Pizzarello
authors.forename: John C
authors.initials: JC
authors.lastname: Richmond
authors.forename: Neil
authors.initials: N
authors.lastname: Pathare
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods; D002102:Cadaver; D005269:Femur / Q000033:anatomy & histology*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control; D007719:Knee Joint / Q000033:anatomy & histology* / Q000601:surgery*; D008023:Ligaments, Articular / Q000033:anatomy & histology / Q000637:transplantation; D019651:Plastic Surgery Procedures; D015203:Reproducibility of Results; D012421:Rupture / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D013709:Tendon Transfer / Q000379:methods*; D013710:Tendons / Q000033:anatomy & histology / Q000637:transplantation; D013977:Tibia / Q000033:anatomy & histology*