2015 ISAKOS Biennial Congress ePoster #1273

Tunnel Position in Anatomic Rectangular Tunnel (ART) Anterior Cruciate Ligament Reconstruction

Take Yasuhiro, MD, PhD, Osaka, Osaka JAPAN
Konsei Shino, MD, PhD, Osaka, Osaka JAPAN
Shigeto Nakagawa, MD, Osaka, Osaka JAPAN
Yuta Tachibana, MD, PhD, Sakai, Asia JAPAN
Yasukazu Yonetani, MD, PhD, Hirakata, Osaka JAPAN
Ken Nakata, MD, PhD, Suita, Osaka JAPAN
Tatsuo Mae, MD, PhD, Suita, Osaka JAPAN

Yukioka Hospital, Osaka, Osaka, JAPAN

FDA Status Not Applicable

Summary: Tunnels created by ART ACLR were sufficiently anatomic, and thus ART ACL Reconstruction is considered to be a suitable technique to mimic the native ACL using a BTB graft.




Tunnel position in ACL reconstruction (ACLR) is a key factor to postoperatively restore kinematics as well as stability of the knee. We developed ‘novel ACLR technique’ and named it “Anatomic Rectangular Tunnel (ART) ACL Reconstruction”. However, precise tunnel locations of the procedure have little been described. The purpose of this study was to evaluate the femoral and tibial tunnel positions created in ART ACLR procedure.
Patients and methods: Subjects were 65 consecutive patients (47 male; 18 female; mean age, 22.6 years) that had undergone primary ACLR by ART technique in our institution. The technique was precisely described by Arthroscopy in 2008. Briefly, for the femoral side, 5 x 10-mm rectangular tunnel was created between the ridge and the posterior cartilage margin, in parallel with the ridge. For the tibial side, 5 x 10-mm tunnel was created along the medial tibial spine in accordance with the anteroposterior width of the lateral meniscus. At three weeks postoperatively, operated knees were scanned using computed tomography to obtain a sagittal 3D-reconstructed view of the lateral wall of the femoral intercondylar notch and a bird-eye one of the tibial plateau. Centroid of each tunnel aperture was determined, and its position was evaluated by coordinate system of quadrant method.


The femoral tunnel was located at 17.8±3.4% from the proximal condylar surface (parallel to the Blumensaat line), and at 40.9±6.3% from the notch roof (perpendicular to the Blumensaat line). The tibial tunnel was located at 44.6±1.6 % of the medial-to-lateral tibial plateau width, and at 35.7±4.0% of the anterior-to-posterior tibial plateau depth.


According to previous studies on tunnel positions after double bundle ACLR, midst of the anteromedial (AM) and posterolateral (PL) femoral tunnels varied from 23.9% to 29.9% from proximal condylar surface and from 30.0% to 44.3% from the notch roof for the femoral tunnel, while that of the tibial tunnels ranged from 48.9% to 51.5% of the medial-to-lateral tibial plateau width and from 35.7% to 43.9% to the anterior-to-posterior tibial plateau depth for the tibial tunnel. In contrast to them, the femoral tunnel in this study was deeper and lower, and the tibial tunnel was more medial and anterior. When the coordinate system of quadrant method was applied to the femoral and tibial insertions of the native ACL demonstrated in the cadavers by Otsubo et al., centroid of the femoral insertion was 17.2% from proximal condylar surface and 41.6% from the notch roof, and that of the tibial insertion was 44.3% from the medial-to-lateral tibial plateau width and 37.6% from the anterior-to-posterior tibial depth. Thus, the tunnel locations in ART ACLR were very close to those shown in the cadaver study.


Tunnels created in ART ACLR were sufficiently anatomic. ART ACL Reconstruction is a suitable technique to mimic the native ACL using a BTB graft.