Three-Dimensional Reconstruction Computed Tomography Evaluation of Tunnel Location during Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of Transtibial and

Background: Anatomic tunnel positioning is important in anterior cruciate ligament (ACL) reconstructive surgery. Recent stud-ies have suggested the limitations of a traditional transtibial technique to place the ACL graft within the anatomic tunnel posi-tion of the ACL on the femur. The purpose of this study is to determine if the 2-incision tibial tunnel-independent technique can place femoral tunnel to native ACL center when compared with the transtibial technique, as the placement with the tibial tunnel-independent technique is unconstrained by tibial tunnel. Methods: In sixty-nine patients, single-bundle ACL reconstruction with preservation of remnant bundle using hamstring tendon autograft was performed. Femoral tunnel locations were measured with quadrant methods on the medial to lateral view of the lateral femoral condyle. Tibial tunnel locations were measured in the anatomical coordinates axis on the top view of the proximal tibia. These measurements were compared with reference data on anatomical tunnel position. Results: With the quadrant method, the femoral tunnel centers of the transtibial technique and tibial tunnel-independent tech-nique were located. The mean ( ± standard deviation) was 36.49 % ± 7.65 % and 24.71 % ± 4.90%, respectively, from the over-the-top, along the notch roof (parallel to the Blumensaat line); and at 7.71 % ± 7.25 % and 27.08 % ± 7.05%, from the notch roof (perpendicular to the Blumensaat line). The tibial tunnel centers of the transtibial technique and tibial tunnel-independent tech