Aim: To evaluate whether a guiding pin for a femoral tunnel could be positioned through the tibial tunnel into the center of the anatomical ACL attachment. Methods: 77 knees underwented arthroscopic ACL reconstruction with hamstrings. The femoral tunnel was drilled through an anteromedial portal at the center of the anatomic insertion at about 10.00 resp.14.00 position. Tibial tunnel (mean diameter 7.55 ± 0.54 mm) was drilled using a guide inserted at 90 degrees of knee flexion. Then, through the tibial tunnel, a 4mm offset femoral drill guide was positioned as close as possible to the femoral tunnel and a 2.5 mm guide wire was drilled. The position of the guide wire was photographed arthroscopically and the deviation was measured as the distance between the center of the femoral tunnel and the guide wire. Results: The mean deviation was 4.50 ± 1.54 mm (p = 0.00000004) In 74 knees (96.1%) the guidewire did not reach the femoral tunnel. Only in 3 knees it reached the superomedial edge of the femoral tunnel. No statistical relationship was found between deviation and tibial tunnel inclination angles or tibial tunnel diameter. Conclusions: Transtibial femoral tunnel drilling does not reach the anatomic site of the ACL insertion, even with larger tibial tunnels (for hamstring grafts up to 8.5 mm). Transtibial tunnel drilling should be replaced by drilling through the anteromedial portal at least for tunnels with diameters < 9 mm.

Introduction: The goal of this prospective, randomized study is the functional evaluation of two different techniques of ACL reconstruction by using the bone-patella tendon (BPT) vs. hamstrings (ST/G).62 ACL-insufficient patients without any concommitent sport injuries took part in a prospective randomized study.

Material and Methods: Eighteen men and 13 women underwent ACL-reconstruction with BPT graft (Group I) with average age 29,87 (16–46) years. 31 patients (16 women and 15 men) with average age 34,23 (16–55) years underwent ACL-reconstruction using a quadrupled hamstrings graft (Group II). Both techniques were performed by using a press-fit and implant-free technique. We used the same accelerated rehabilitation protocol for both groups. The patients were evaluated by IKDC, Lysholm and Tegner scoring systems, KT 1000, one leg hop, isokinetics, internal torque, kneeling and knee walking test, 1 day preoperatively (VU), and 3 (NU I), 6 (NU II) and 12 months (NU III) postoperatively.

Results: One year postop.the results of Group II (30 patients classified as A and B) were according to IKDC scoring system better than those in Group I (Group I: 24 patients classified as A and B). We had similar results according to Lysholm-scoring evaluation (Group 11:95,61 points vs. 90,87 in Group I (p=0.017)) and Tegner-scoring (Group II: 7,07 vs. 6,61 in Group I (p=0.00)). According to the KT 1000 stability evaluation, there was no statistical significant difference between injured and uninjured knees in both groups. The evaluation of the strength of the hamstrings by isokinetics in both groups showed statistical significant differences (Group II: 90,34 Nm vs. 99,19 Nm in Group I, (p=0.008)). However, our results concerning internal torque evaluation were not statistical significant. The evaluation of one leg hop by comparing injured and non-injured leg showed a significant difference between group II and group I (Group II: 96% vs. 91% in Group I, (p=0.012)). We had worse results in Group I vs. Group II at kneelling and knee-walking-testings ((p=0.00)(p=0.00)), concerning the anterior knee pain.

Conclusion: From our results concerning IKDC, Lysholm, Tegner, kneeling and knee walking tests it seems that hamstrings can be recommended for ACL reconstruction. The isokinetic evaluation of hamstrings showed a statistical significant deficiency compaired to the BPT-group. But this result could not be confirmed with the internal torque evaluation and “one leg hop”-testing.

Introduction: The aim of this study was to evaluate whether a guiding pin for a femoral tunnel could be positioned through the tibial tunnel into the center of the anatomical ACL attachment.

Material and Methods: We studied 77 knees who underwented arthroscopic ACL reconstruction with hamstrings. The femoral tunnel was drilled through an antero-medial portal at the center of the anatomic insertion at about 10 resp. 2 o’clock position. Tibial tunnel (mean diameter 7.55 ± 0.54 mm ) was drilled at 90° of knee flexion. The aiming point was on a line, being a “prolongation” of the posterior border of the anterior horn of the lateral meniscus and at exactly 60% of the distance from the end of the anterior horn of the lateral meniscus and the medial tibial spine. Then, through the tibial tunnel, a 4mm offset femoral drill guide was positioned as close as possible to the femoral tunnel and a 2.5 mm guide wire was drilled. The position of the guide wire was photographed arthroscopically and the deviation was measured as distance between the center of the femoral tunnel and guide wire.

Results: The mean angle of the tibial tunnel in the coronar plain was 27,53° and in the sagittal plain 25,84°, both according to the longitudinal axis of the tibia. In 74 knees ( 96. 1 % ) the guidewire did not reach the femoral tunnel. Only in 3 knees it reached the superomedial edge of the femoral tunnel. The mean deviation was 4.50 ± 1.54 mm (p = 0.00000004 ). No statistical relationship was found between deviation and tibial tunnel inclination angles or tibial tunnel diameter.

Conclusion: Transtibial femoral tunnel drilling did not reach the anatomic side of the ACL insertion in most of the cases, even with larger tibial tunnels (for hamstring grafts up to 8.5 mm). Therefore we recommend tibial tunnel drilling through the anteromedial portal.

Aim of the study: To evaluate whether additional aperture fixation to distal fixation (two-point fixation or 2P) may diminish tibial tunnel enlargement compared to distal fixation alone (one-point fixation or1P).

Methods: Two groups of patients were evaluated. In group 1P (44pts.) the grafts were fixed on the tibial side, using two 4 mm Mersilene tapes tied over a 10 mm bone bridge created in the anterior cortex. In group 2P, an additional fixation, using 1 absorbable cross pin in 27 pts. and 2 absorbable cross pins (Rigid fix, Mitek) in 24 pts., was performed. AP and lateral radiographs as well as patients evaluation were performed 3, 6 and 12 months post-op. Tibial tunnel size was measured at the widest diameter in both AP and lateral radiographs.

Results: Tunnel enlargement occurred in both groups at 3 months post-op, but not thereafter. In the lateral radiographs, tunnel enlargement was significantly less in group 2P compared to group 1P (p< 0.05). No statistical relationship was found between tunnel enlargement and gender, age, IKDC, and KT 1000 side-to-side difference.

Conclusion: Additional tibial graft fixation with cross-pins seems to diminish tibial tunnel enlargement in the sagital plane. This may be explained by the fact that the cross pins inserted in the coronal plane, reduce tibial graft movements mainly in the sagital plane. The study supports the hypothesis that tibial graft micro-movements during the period of tendon healing to bone (up to 3m) play a role in tibial tunnel enlargement after ACL reconstruction using hamstrings.