The purpose of this study is to evaluate the relationship between the clinical results and the angle of the reconstructed ligament measured radiographically. We also describe the comparison of the results by the fixation technique of the femoral tunnel. We retrospectively evaluated 90 patients who had arthroscopy assisted ACL reconstruction using middle-third middle-third bone patellar tendon autograft. There were 67 men and 23 women. Their average age at surgery was 23.9 years. The average follow up periods was 28.0 months. We used interference fit screw for grafted ligament fixation of the femoral and tibial tunnel. 71 patients received inside out technique and on 19 patients outside in technique as for the fixation of the femoral funnel. The lateral angle and A-P angle of the reconstructed ligament were measured roentgenographically. Data from KT-2000 arthrometer testing with side to side difference and Lachman test were used to assess postoperative anterior knee laxity. Pivot shift tests were also used for rotational knee laxity. Data from roentgenograms reflected the correlation with clinical testing. Mean value of the side to side difference was 1.3mm. In pivot shift test, the average lateral angle of the reconstructed ligament of negative group was 73.2o , while positive group was 77.2 o , it was statistically significant. The average lateral angel and A-P angle of the reconstructed ligament with inside out technique group was larger than those of outside in technique group. Recent recommendations placing the tibial tunnel more posterior results in a lower incidence of graft impingement, but we found a relationship between the angle of the reconstructed ligament and rotational stability of the knee. Anterior-posterior stability can be obtained by achieving posterior placement of the reconstructed ligament. More vertical graft angle caused by posterior placement of tibial tunnel should affect rotational stability. Inside out as the way of fixation technique for the femoral tunnel showed a tendency of more vertical graft angle.
