Articles Vol. 67 No. CĐ8-NCKH 06/07/2026

ASSESSMENT OF FEMORAL AND TIBIAL TUNNEL POSITIONS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING 3D COMPUTED TOMOGRAPHY

Nguyen Ba Son1,2,3,4, Ngo Xuan Tuan1,2,3,4, Nguyen Anh Quan1,3, Nguyen Tuan Anh1,3
1 Phenikaa University Hospital
2 School of Medicine and Pharmacy, Phenikaa University
3 Bệnh viện Đại học Phenikaa
4 Trường Y Dược, Đại học Phenikaa
DOI: 10.52163/yhc.v67iCD8.5658
29 Views
0 Downloads
Keywords
ACL reconstruction, 3D CT, tunnel position, femur, tibia, anatomical footprint.
Abstract

Objective: To quantitatively describe femoral and tibial tunnel positions after anterior cruciate ligament (ACL) reconstruction using 3D computed tomography (3D CT).

Subjects and methods: A cross-sectional descriptive study was conducted on 34 patients undergoing primary ACL reconstruction using the All-inside technique. Postoperative 3D CT images were used to identify tunnel center positions. The femoral tunnel position was measured using the quadrant method with depth (t%) and height (h%) coordinates, while the tibial tunnel was evaluated using anterior-posterior (AP%) and medial-lateral (ML%) coordinates. Measured values were compared with published anatomical references.

Results: The mean femoral tunnel position was 31.1 ± 0.7% (t%) and 35.5 ± 1.4% (h%). Both were within the anatomical range but showed statistically significant differences from reference values (p < 0.05). The mean tibial tunnel position was 41.4 ± 1.2% (AP) and 47.9 ± 0.5% (ML), also within the anatomical range. The AP coordinate showed no significant difference (p = 0.393), while the ML coordinate differed significantly (p < 0.001). The proportion of tunnels within the anatomical footprint was 52.9% for the femur and 82.4% for the tibia. Femoral tunnel deviations were mainly anterior (23.5%) and inferior (23.5%), while tibial tunnel deviations were mainly medial (11.8%) and posterior (5.9%).

Conclusion: Most tunnels were located within the anatomical footprint, but a notable proportion, especially in the femur, did not reach the optimal position. These findings suggest that reliance on anatomical landmarks alone may not ensure accuracy, and adjustments in tunnel positioning technique are needed. 3D CT provides quantitative assessment and may improve accuracy in anatomical ACL reconstruction.

References
[1]
Burnham J.M, Malempati C.S, Carpiaux A et al. Anatomic femoral and tibial tunnel placement during anterior cruciate ligament reconstruction: anteromedial portal all-inside and outside-in techniques. Arthroscopy Techniques, 2017, 6 (2): e275-282. doi: 10.1016/j.eats.2016.09.035. Google Scholar
[2]
Ducouret E, Loriaut P, Boyer P et al. Tunnel positioning assessment after anterior cruciate ligament reconstruction at 12months: comparison between 3D CT and 3D MRI. A pilot study. Orthop Traumatol Surg Res, 2017, 103 (6): 937-42. doi: 10.1016/j.otsr.2017.06.005. Google Scholar
[3]
Min-Jeong Kim, Sung-Gyu Moon et al. Usefulness of 3-Dimensional computed tomography assessment of femoral tunnel after anterior cruciate ligament reconstruction. Medicina (Kaunas, Lithuania), 2023, 59 (10): 1716. doi: 10.3390/medicina59101716. Google Scholar
[4]
McConkey M.O, Amendola A, Ramme A.J et al. Arthroscopic agreement among surgeons on anterior cruciate ligament tunnel placement. Am J Sports Med, 2012, 40 (12): 2737-46. doi: 10.1177/0363546512461740. Google Scholar
[5]
Śmigielski R, Zdanowicz U, Drwięga M et al. The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction. Bone Joint J, 2016, 98-B (8): 1020-6. doi: 10.1302/0301-620X.98B8.37117. Google Scholar
[6]
Xu H, Zhang C, Zhang Q et al. A systematic review of anterior cruciate ligament femoral footprint location evaluated by quadrant method for single-bundle and double-bundle anatomic reconstruction. Arthroscopy, 2016, 32 (8): 1724-34. doi: 10.1016/j.arthro.2016.01.065. Google Scholar
[7]
Lee S.S, Kim I.S, Shin T.S et al. Femoral tunnel position affects postoperative femoral tunnel widening after anterior cruciate ligament reconstruction with tibialis anterior allograft. J Clin Med, 2023, 12 (5): 1966. doi: 10.3390/jcm12051966. Google Scholar
[8]
Chen T, Chen J, Li X et al. A comparative study on 3D printingassisted arthroscopic IDEAL point femoral tunnel positioning for anterior cruciate ligament reconstruction versus conventional arthroscopic positioning. BMC Musculoskeletal Disorders, 2024, 25: 481. doi: 10.1186/s12891-024-07591-y. Google Scholar
[9]
Youm Y.S, Cho S.D, Eo J et al. 3D CT analysis of femoral and tibial tunnel positions after modified transtibial single bundle ACL reconstruction with varus and internal rotation of the tibia. The Knee, 2013, 20 (4): 272-6. doi: 10.1016/j.knee.2012.10.024. Google Scholar
[10]
de Padua V.B.C, Saithna A, Chagas E.F.B et al. Rate of tibial tunnel malposition is not changed by drilling entirely within the stump of preserved remnants during acl reconstruction: a prospective comparative 3D-CT study. Orthop J Sports Med, 2021, 9 (10): 23259671211037324. doi: 10.1177/23259671211037324. Google Scholar