Radiologic Evaluation of Femoral and Tibial Tunnels Created With the Transtibial Tunnel Technique for Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Purpose: The purpose of this study was to clarify femoral and tibial tunnel angles in anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Methods: A prospective study was performed in 50 consecutive patients who underwent anatomic double-bundle ACL reconstruction via hamstring tendon grafts for chronic ACL deficiency in the unilateral knee. For this procedure, 2 hamstring tendon grafts were secured with EndoButtons (Smith & Nephew Endoscopy, Andover, MA) on the femur and with 2 staples on the tibia. Each patient underwent radiologic examination 1 year after surgery. Results: The tibial tunnel angles of the posterolateral bundle averaged 40.7° in the anteroposterior view and 35.4° in the lateral view. The tibial tunnel angles of the anteromedial bundle averaged 15.6° in the anteroposterior view and 41.4° in the lateral view. The femoral tunnel angles of the posterolateral bundle averaged 44.0° in the anteroposterior view and 52.0° in the lateral view. The femoral tunnel angles of the anteromedial bundle averaged 18.0° in the anteroposterior view and 49.8° in the lateral view. Conclusions: The given data will be useful for surgeons to evaluate the tunnel positions and standardization postoperatively in anatomic double-bundle reconstruction. Level of Evidence: Level II, development of diagnostic criteria on the basis of consecutive patients with universally applied reference gold standard.