Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction.

Abstract

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. 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. 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. This investigation showed that better clinical results are associated with anatomic ACL reconstructions. Level II, prospective comparative study.