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World J Orthop. Mar 18, 2015; 6(2): 252-262
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.252
Review of evolution of tunnel position in anterior cruciate ligament reconstruction
Faizal Rayan, Shashi Kumar Nanjayan, Conal Quah, Darryl Ramoutar, Sujith Konan, Fares S Haddad
Faizal Rayan, Shashi Kumar Nanjayan, Conal Quah, Darryl Ramoutar, Orthopeadics, King’s Mill Hospital, Sutton-in-Ashfield, NG17 4JL Nottinghamshire, United Kingdom
Sujith Konan, Fares S Haddad, Orthopaedics, University College Hospital, NW1 2BU London, United Kingdom
Author contributions: All authors contributed to this paper.
Conflict-of-interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Faizal Rayan, Mrcsed, D.Orth, SPR in Orthopeadics, King’s Mill Hospital, Sutton-in-Ashfield, Mansfield Road, NG17 4JL Nottinghamshire, United Kingdom. rayanmarakkar@yahoo.co.uk
Telephone: +44-78-60454942
Received: May 28, 2014
Peer-review started: May 29, 2014
First decision: August 18, 2014
Revised: December 1, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: March 18, 2015
Abstract

Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established.

Keywords: Anterior cruciate ligament, Anatomy, Biomechanics, Isometry, Tunnel

Core tip: We are mainly focussing on the evolution of tunnel placement in anterior cruciate ligament (ACL) reconstruction especially on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched and still ongoing. Due to the nature of the intervention it is difficult to attain definite clinical and functional data to establish the superiority of the single or double bundle reconstruction technique.