Effect of tibial tunnel position on arthroscopically assisted anterior cruciate ligament reconstruction using bone-patellar tendon-bone grafts: a prospective study.
BACKGROUND
The aim of this research was to study the effect of the tibial tunnel position in anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) grafts in ensuring optimal knee functioning.


METHODS
A prospective study was conducted on 41 patients who underwent arthroscopically assisted ACL reconstruction using a BPTB graft and who were followed up for a minimum period of two years. The radiographic position of the tibial tunnel was compared with the clinical outcome using the International Knee Documentation Committee (IKDC) and modified Lysholm knee scores at two years after surgery.


RESULTS
Six out of eight patients with a fair outcome based on the modified Lysholm score and five out of eight patients with an abnormal outcome based on the IKDC score had their tibial tunnel within the 10 percent to 25 percent anteroposterior width of the tibial plateau. The tibial tunnel of patients with a fair Lysholm outcome (mean 22.2 percent) was significantly anterior compared to that of those with an excellent (mean 38.1 percent) and good (mean 34.1 percent) outcome (p is less than 0.01). The analysis using the IKDC score showed a similar trend.


CONCLUSIONS
Placing the tibial tunnel in the anterior 25 percent of the tibial plateau is associated with a poor knee outcome. More predictable results can be achieved through 35 percent to 46 percent anteroposterior placement of the tibial tunnel.
Avadhani
A
A
Department of Orthopaedics, Kasturba Medical College, Madhav Nagar, Manipal 576104, Karnataka, India. ashwinavadhani@yahoo.com
Rao
P S
PS
Rao
S K
SK
D000704:Analysis of Variance; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000379:methods*; D050376:Bone-Patellar Tendon-Bone Grafting / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D015999:Multivariate Analysis; D011446:Prospective Studies; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013977:Tibia / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome