Anterior position of ACL reconstruction tunnels
History of ACL repair in left knee done 2 years prior, now complains of restricted extension .
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The femoral tunnel should normally be posterior to the junction of the posterior cortical line of femur and roof of intercondylar notch. In this case it is seen anterior to this point.
The tibial tunnel should be posterior and parallel to the Roof of the intercondylar notch depicted by the blumensaat line, in this case it is also anteriorly placed.
Graft position in ACL reconstruction is crucial to mimic the biomechanics of the original ACL.
Far anterior position of tibial tunnel causes roof impingement of ACL leading to restricted extension and premature degeneration of graft with tear.
Far posterior tibial tunnel causes knee instability
Far anterior femoral tunnel leads to elongation of graft again leading to instability