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<p class="abstract">The ankle joint is the most commonly injured joint during sports activity. While ankle sprains occur more frequently, ankle fractures are less common. Due to its low incidence, the isolated fracture of the posterior malleolus still represents a diagnosis challenge. This article reports a case of a female with a posterior malleolus isolated fracture after falling while performing sports activity. Clinical examination and conventional radiography were consistent with diagnosis of a simple ankle sprain and the patient was discharged with a conservative approach for lateral ankle sprain. Due to persistent pain the patient return for additional examination, which the differential diagnosis revealed an isolated fracture of the posterior malleolus without displacement of the fragment. The patient was immobilized with a suropodalic splint for 4 weeks followed by additional conservative. At the fourth month of follow-up, the patient was asymptomatic and showed good clinical and functional outcomes. This case highlights the importance of a comprehensive medical history and detailed clinical examination which may reveal pathological features that require a differential diagnosis<span lang="EN-IN">.</span></p>

INTRODUCTIONCorrect tunnel positioning in anterior cruciate ligament (ACL) reconstruction surgery is one of the keystones for success and is still an important question among orthopedic surgeons. However, the correct location of the femoral and tibial tunnels is still controversial and target of disagreement within the scientific literature. The known problems include femoral notch impingement and graft versus posterior cruciate ligament (PCL) impingement. Fortunately, tibial tunnel placement error has less negative impact in graft function than the femoral tunnel and probably, by this reason, the impact in the literature regarding this subject is less common.1 To achieve optimal surgical performance the surgeon requires practice and continuous execution of the surgical procedure.2 Therefore, it was decided to study the tibial tunnel placement in ACL reconstruction surgeries of a single surgeon in his first 32 cases during a 6 years period in order to identify a correlation between the number of cases performed by year and the correct placement of the tunnel, as well as, the evolution along the years on the positioning. METHODSIt was retrospectively analyzed the radiographs of 32 patients submitted to ACL reconstruction surgery by a single senior surgeon (LC) between 2009 and 2015 (these were the first cases performed by the surgeon with ABSTRACT Background: Accurate tunnel positioning in anterior cruciate ligament reconstruction surgery is one of the cornerstones for its success. However, it is still controversial and target of disagreement within the orthopedic literature. Therefore, it was aimed to evaluate the tibial tunnel placement in anterior cruciate ligament reconstruction surgeries of a single orthopedic surgeon. Methods:The postoperative knee sagittal radiographs of anterior cruciate ligament reconstructed knees from a single surgeon were retrospectively collected. To assess the tunnel positions was used predefined criteria (in percentage and in millimeters) within the intervals found in the literature (41-43 percent and 21-23 millimeters). Results: There were no significant differences between the number of results (% and mm), within and without the intervals that were considered acceptable for this measure (P >0.05). It was found significant differences in the absolute deviation (%) throughout non-consecutive years (P <0.05). There was no correlation between the absolute deviations and the years of experience (r =-0.080, P =0.663). Conclusions: Significant differences were found in the absolute deviation (%) throughout non-consecutive years, suggesting variations in the tunnel position throughout the years.