Introduction We performed an audit of tunnel position in primary anterior cruciate ligament reconstructions performed by two surgeons at a single centre. The audit cycle was opened with a retrospective review of a cohort of patients in order to establish existing surgical practice. Following this review our practice changed with the use of intra-operative image intensifier to confirm tunnel positions. The audit loop was closed with a prospective study of a second cohort of patients undergoing surgery using the new technique.

Results Twenty five patients were reviewed in each group. The case-mix for the two groups were similar with regard to age, sex, side, graft selection and surgical technique. The first cohort of patients had optimal tibial tunnel placement in 56% (sagittal) and 88% (coronal) of cases. The femoral tunnel was correctly positioned in the sagittal plane in 52% of patients. The second cohort, in which an intra-operative image-intensifier was used, had optimal tunnel position for the femur in 100% of cases and for the tibia (sagittal) in 48% of patients.

Conclusion In this study we have shown that the use of an image intensifier, intra-operatively, greatly improved femoral tunnel position but had no significant effect on tibial tunnel placement. We have also demonstrated that audit is effective in improving clinical practice.