Effect of Femoral Tunnel Placement for Reconstruction of the Anterior Cruciate Ligament on Tibial Rotation

Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study

“…We now drill the femoral tunnel through an anteromedial portal to achieve a lower, more horizontal and, hence, more anatomical position of the ACL [19,20]. However, the clinical relevance of this is still the subject of debate; at present, none of these procedures fully restores both kinematics and biomechanics of the knee [21]. Almost all the patients had gained good stability and good to excellent clinical and functional outcomes, better than those reported in previous studies.…”

Transtibial Versus Independent Drilling Techniques for Anterior Cruciate Ligament Reconstruction

“…One group found that reconstruction through an AMP restored the normal tibial translation profile but led to more tibial rotation than in the normal knee. 54 In a larger study of 84 patients, tibial rotation was measured during level walking. 75 Using a TT technique, the greater the coronal graft obliquity, the more stable the knee was to tibial rotation.…”

Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review

“…The inconsistencies in study findings may be attributed to difficulties in accurately measuring tibial rotation using three-dimensional motion analyses, and differences in task (eg, high-demand vs low-demand) or ACLR technique (eg, single-bundle or double-bundle). For example, there is preliminary evidence that a more obliquely placed femoral tunnel may correct abnormal tibial rotation more effectively,68 82 91–93 but may not be associated with PFJ OA development 94. Both the double-bundle and oblique-tunnel orientation techniques require further investigation into their ability to restore transverse plane kinematics, and thus the ability to protect the PFJ and TFJ from unaccustomed load and OA development or progression.…”