Increased revision rate with posterior tibial tunnel placement after using the 70-degree tibial guide in ACL reconstruction.
OBJECTIVE
To map knee morphology radiographically in a population with a torn ACL and to investigate whether anatomic factors could be related to outcomes after ACL reconstruction at mid- to long-term follow-up. Further, we wanted to assess tibial tunnel placement after using the 70-degree "anti-impingement" tibial tunnel guide and investigate any relation between tunnel placement and revision surgery.


METHODS
Patients undergoing ACL reconstruction involving the 70-degree tibial guide from 2003 to 2008 were included. Two independent investigators analysed pre- and post-operative radiographs. Demographic data and information on revision surgery were collected from an internal database. Anatomic factors and post-operative tibial tunnel placements were investigated as predictors of revision.


RESULTS
Three-hundred and seventy-seven patients were included in the study. A large anatomic variation with significant differences between men and women was seen. None of the anatomic factors could be related to a significant increase in revision rate. Patients with a posterior tibial tunnel placement, defined as 50 % or more posterior on the Amis and Jakob line, did, however, have a higher risk of revision surgery compared to patients with an anterior tunnel placement (P = 0.03).


CONCLUSIONS
Use of the 70-degree tibial guide did result in a high incidence (47 %) of posterior tibial tunnel placements associated with an increased rate of revision surgery. The current study was, however, not able to identify any anatomic variation that could be related to a higher risk of revision surgery. Avoiding graft impingement from the femoral roof in anterior tibial tunnel placements is important, but the insight that overly posterior tunnel placement can lead to inferior outcome should also be kept in mind when performing ACL surgery.


METHODS
IV.
Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway. eivind.inderhaug@gmail.com.
Eivind
http://orcid.org/0000-0001-7959-163X
E
Inderhaug
Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Sveinung
S
Raknes
Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Thomas
T
Østvold
Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway.|Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
Eirik
E
Solheim
Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway.
Torbjørn
T
Strand
D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D017760:Bone Malalignment; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology* / Q000601:surgery; D008297:Male; D017063:Outcome Assessment, Health Care; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013977:Tibia / Q000601:surgery*; D055815:Young Adult
70-Degree tibial guide; ACL; Anterior cruciate ligament reconstruction; Impingement
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