title: Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  The purpose of this study was to correlate anatomic and nonanatomic tibial and femoral tunnel positions after anterior cruciate ligament (ACL) reconstruction with clinical outcome by use of bone-patellar tendon-bone (BPTB) single-bundle (SB) and semitendinosus-gracilis (STG) double-bundle (DB) techniques.
  
  
  METHODS
  The 3-dimensional computed tomography scans of 53 patients' knees (27 BPTB-SB and 26 STG-DB) were prepared and measured by 2 examiners according to their tibial and femoral tunnel positions. We evaluated these radiologic constructions and measurements by use of the Cohen κ interobserver and intraobserver coefficient for 2 observers. Patients undergoing both techniques were divided into anatomic and nonanatomic reconstructions according to the findings of Zantop and Petersen. We correlated anatomically and nonanatomically reconstructed patients with clinical outcome by the Tegner score, Western Ontario and McMaster Universities Osteoarthritis Index score, International Knee Documentation Committee score, KT-1000 arthrometer (MEDmetric, San Diego, CA), and pivot-shift test in both techniques.
  
  
  RESULTS
  The radiologic constructions and measurements of 53 computed tomography scans were achieved with a good agreement of interobserver and intraobserver coefficients for 2 observers. We found significantly superior clinical outcome in anatomic ACL reconstructions in both techniques in terms of higher clinical scores (Tegner and International Knee Documentation Committee), higher anterior posterior stability, and less pivot shift. We observed the best outcome in anatomic STG-DB reconstructions.
  
  
  CONCLUSIONS
  This investigation showed that better clinical results are associated with anatomic ACL reconstructions.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Orthopaedics, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sadoghi
authors.forename: Albert
authors.initials: A
authors.lastname: Kröpfl
authors.forename: Volkmar
authors.initials: V
authors.lastname: Jansson
authors.forename: Peter E
authors.initials: PE
authors.lastname: Müller
authors.forename: Matthias F
authors.initials: MF
authors.lastname: Pietschmann
authors.forename: Martin F
authors.initials: MF
authors.lastname: Fischmeister
mesh_terms: D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D050376:Bone-Patellar Tendon-Bone Grafting; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D011446:Prospective Studies; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012399:Rotation; D012421:Rupture; D018709:Statistics, Nonparametric; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome