Tibial Tunnel Placement for ACL Reconstruction

Although extensive research has been carried out on Anterior Cruciate Ligament (ACL) femoral
tunnel placement, very little attention has been given to the tibial tunnel. Researchers
have suggested that the tibial tunnel be placed in the center of the ACL footprint, which
they described as being approximately 43% of the way (anterior-to-posterior) across the
proximal tibia at its widest extent. However, others have suggested that a more anterior
placement may yield improved biomechanical and clinical results. The center of the ACL
footprint and the posterior aspect of the anterior horn of the lateral meniscus does not
yield tibial tunnel placement a consistent percentage of the way across the tibial plateau;
therefore, guidelines should be based on intraoperative fluoroscopic measurements. However,
the question remaining is what percentage of the anterior-to-posterior distance across the
tibia is the ideal location for the tibial tunnel in ACL reconstruction. This study will
help answer that question.

Patients with a diagnosed rupture of the ACL who are scheduled for surgical reconstruction
will be considered for enrollment. Eligible patients will be allocated to one of two groups
based on the location of the tibial tunnel (anterior vs. posterior) during the surgical
procedure. In addition to a baseline (pre-operative) evaluation, participants will return
for follow-up visits at 6, 12, and 24 months post-surgery. Follow up will be completed at 24
months.

The primary objective of this study is to collect subjective and objective measures of
knee-related function in patients with an anterior vs. posterior placed tibial tunnel
through 24 months postoperative care.