What does this research mean for the field?

Tibial tunnel malposition during anatomical single-bundle anterior cruciate ligament reconstruction does not significantly affect mid-term knee stability and clinical outcomes, although posterior placement may impact pain scores. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine how the location of the tibial tunnel affects knee function and stability after ACL reconstruction using hamstring autografts.

June 6, 2026

Does Tibial Tunnel Placement Affect Postoperative Function and Isokinetic Outcomes in Patients Undergoing Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction with Hamstring Autograft?

Key Points

To determine how the location of the tibial tunnel affects knee function and stability after ACL reconstruction using hamstring autografts.
Retrospective evaluation of MRI scans from 34 patients post-ACL reconstruction
Tibial tunnel location assessed using anatomical landmarks and contralateral knee scans
Evaluation of knee stability, muscle strength, and clinical outcomes using validated scores
Patients with a posterior tunnel position had lower KOOS pain scores (p = 0.023) than those with a regular position
No significant differences in pivot shift, isokinetic test results, or other KOOS scores were observed between groups
High agreement between measurement techniques with kappa value of 0.681 (p < 0.001)

Abstract

Background: Tunnel malposition is a frequent complication of anterior cruciate ligament (ACL) reconstruction. We evaluated whether the tibial tunnel location of patients who underwent anatomical single-bundle ACL reconstruction with hamstring tendons affected knee stability, muscle strength, and clinical outcomes. Methods: We retrospectively evaluated operated and normal knee MRI scans of 34 patients who underwent anatomical single-bundle ACL reconstruction technique with hamstring tendons. Tibial tunnel location was measured according to two techniques: anatomical landmarks of tibial footprint and contralateral normal knee ACL anatomical scans. The effect of tibial tunnel location on knee stability, isokinetic and single-leg hop test (SLHT) results, and Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC-2000) scores were evaluated. Results: For tunnel position evaluated by anatomical landmark methods, patients were defined as regular footprint in 23 patients, anterior in 5, and posterior in 6. Similarly, tibial tunnel positions evaluated by contralateral footprint, twenty patients were grouped as regular, 4 as anterior, 6 as posterior, and 4 as medial tibial tunnel position. Groups were compared according to both techniques. KOOS pain scores were significantly different in posterior tunnel position patients compared to patients with regular position (p = 0.023). No significant difference was found between the pivot shift, Kneelax 3 anterior translation and SLHT, and leg symmetry index (LSI). Isokinetic test results and IKDC and other KOOS scores of all groups were similar. The kappa value between two measurement techniques was 0.681, and the agreement between techniques was 82% (p < 0.001). Conclusion: Tibial tunnel position may not be optimal because of technical reasons. Tunnel malposition does not significantly affect the stability and clinical outcomes of the patients in mid-term results. We can evaluate tibial tunnel only with the operated knee’s routine control MRI scans. Key Words: Anterior cruciate ligament reconstruction, single-bundle, tibial tunnel position, MRI

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Cite This Study

Arslantaş et al. (Thu,) studied this question.

synapsesocial.com/papers/6a23ba6871a5da9775e76205 https://doi.org/https://doi.org/10.1055/a-2886-7914

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