Femoral Tunnel Three Approach Comparison for Double Bundle Anterior Cruciate Ligament Reconstruction

Background: There is a lot of controversy surrounding the technique of femoral tunnel placement during reconstruction of anterior cruciate ligament. By our study we attempt to clarify the controversy by using three different techniques for femoral tunnel position with the same concept of tunnel creation and supported measurement data.

Methods: The creation of the femoral tunnel placement of double bundle ACL reconstruction was carried out using the behind remnant approach. The Transtibial approach was carried out for all primary Anterior Cruciate Ligament injury cases till December 2017. After that, from January 2018 to September 2018 we used the Trans-portal approach followed by which the Outside In approach was used from October 2018 to March 2019. We compared the tunnel position with a 3D reconstructed computer tomography image. We also analyzed through our study the length of each femoral tunnel and the distance between septum of every anteromedial and posterolateral tunnel.

Results: The aperture of the anteromedial bundle tunnel position in Transtibial method was higher and shallow as compared to that Trans-portal method. Also, the tunnel length in Trans-portal was shorter as compared to the Transtibial method and the Outside In approach.

Conclusion: There is a risk of antero-medial aperture position in Transtibial approach being high and shallow, whereas Trans-portal approach runs the risk of short tunnel length. Hence, we could conclude that it is important to apply any of the methods flexibly to each case as there is no data supporting a single best approach.