Effect of Femoral Tunnel Position on Stability and Clinical Outcomes After Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Outside-In Technique

Purpose: To evaluate the effects of the femoral tunnel location in the femoral footprint of the anterior cruciate ligament (ACL) on postoperative knee stability and clinical outcomes after ACL reconstruction (ACLR) using the outside-in technique.

Methods: From December 2012 to August 2014, ACLR was performed using the outside-in technique in 137 patients. Among these patients, those who had a follow-up period of over 2 years were retrospectively reviewed. A total of 102 patients met the inclusion criteria. The relative location of the femoral tunnel in the lateral condyle was evaluated as a percentage using the standardized grid system on a 3-dimensional computed tomography image. Each patient was then classified into the anterior group, center group (anteroposterior plane, 29.3% ± 3.5%), or posterior group depending on the location of the femoral tunnel. Knee laxity was evaluated using a GNRB knee arthrometer, stress radiography, and the pivot-shift test. From a clinical perspective, patient-reported outcomes (International Knee Documentation Committee subjective form and Lysholm knee score) were then evaluated.

Results: Of 102 patients, 31 (30.4%) were assigned to the anterior group, 46 (45.1%) were assigned to the center group, and 25 (24.5%) were assigned to the posterior group. Postoperative side-to-side differences, which were measured using stress radiographs and the GNRB arthrometer, were significantly smaller in the posterior group (1.7 ± 0.6 mm and 1.5 ± 0.5 mm, respectively) than in the center group (2.3 ± 0.9 mm and 2.2 ± 2.8 mm, respectively) and anterior group (2.4 ± 0.7 mm and 2.4 ± 1.3 mm, respectively) (P = .002 for stress radiography and P = .002 for GNRB arthrometer). No significant between-group differences were observed in the pivot-shift test results and patient-reported outcomes among the 3 groups.

Conclusions: The location of the femoral tunnel in the anatomic ACL footprint did not affect postoperative stability and clinical outcomes in the case of ACLR using the outside-in technique.

Level Of Evidence: Level III, retrospective comparative study.