title: Anatomic Placement of the Femoral Tunnels in Double-Bundle Anterior Cruciate Ligament Reconstruction Correlates With Improved Graft Maturation and Clinical Outcomes.
abstract: OBJECTIVE
  To compare maturation of reconstructed graft on second-look arthroscopy and clinical outcomes between 2 groups: the provisional anatomic (PA) group, with both the anteromedial (AM) and posterolateral (PL) femoral tunnels in their anatomic location, and the nonanatomic (NA) group, with either 1 of the 2 femoral tunnels beyond its anatomic location after double-bundle anterior cruciate ligament reconstruction.
  
  
  METHODS
  We enrolled 154 patients who underwent 3-dimensional computed tomography scanning and second-look arthroscopy after double-bundle anterior cruciate ligament reconstruction. All of the patients were divided into the PA and NA groups according to the femoral tunnel position determined by the quadrant method. Graft maturation was evaluated with 3 subsections, including integrity, tension, and synovial coverage with revascularization, on second-look arthroscopy. We also compared Lachman test, pivot-shift test, KT-2000 (MEDmetric, San Diego, CA), and International Knee Documentation Committee grades at the last follow-up.
  
  
  RESULTS
  Of the 154 patients, 88 were classified as the PA group and 66 as the NA group by the quadrant method. A difference existed between groups for the AM tunnel position but not for the PL tunnel position. The PA group showed a higher graft maturation score (P < .001 for all comparisons) and better results according to the International Knee Documentation Committee knee rating, Lachman test, pivot-shift test, and KT-2000 assessment (P < .001 for all comparisons).
  
  
  CONCLUSIONS
  The PA group with anatomic femoral tunnel placement showed a higher graft maturation score on second-look arthroscopy, along with better clinical outcomes, than the NA group. There was a significant difference in the AM femoral tunnel position but not in the PL tunnel position between the 2 groups.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea. Electronic address: drsky71@duih.org.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Ahn
authors.affiliation: Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
authors.forename: Jong Dae
authors.initials: JD
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
authors.forename: Ho Won
authors.initials: HW
authors.lastname: Kang
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005269:Femur / Q000033:anatomy & histology* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D024162:Second-Look Surgery / Q000379:methods; D013710:Tendons / Q000637:transplantation*; D014057:Tomography, X-Ray Computed / Q000379:methods