Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 49 (3), 352-6

Trans-tibial Guide Wire Placement for Femoral Tunnel in Single Bundle Anterior Cruciate Ligament Reconstruction


Trans-tibial Guide Wire Placement for Femoral Tunnel in Single Bundle Anterior Cruciate Ligament Reconstruction

Skand Sinha et al. Indian J Orthop.


Background: Femoral tunnel location is of critical importance for successful outcome of ACL reconstruction. The aim was to study the femoral tunnel created by placing free hand guide wire through tibial tunnel, using the toggle of the guide wire in the tibial tunnel to improve femoral tunnel location.

Materials and methods: 30 cases of a single bundle quadrupled hamstring graft anterior cruciate ligament reconstruction by trans-tibial free hand femoral tunnel creation is studied in this prospective study. The side to side play of the guide wire in the tibial tunnel was used to improve the tunnel location on femoral wall. The coronal angle of the femoral tunnel was measured on the anteroposterior radiograph. The femoral tunnel location on the lateral radiograph of the knee was recorded according to Amis method. Lysholm scoring was done preoperative and at each follow up. Assessment of laxity was done by Rolimeter (Aircast(™)) and pivot shift test.

Results: The mean coronal angle of the femoral tunnel in postoperative radiograph was 47°. In lateral radiograph, the femoral tunnel was found to be >60% posterior on Blumensaat line in 67% cases (n = 20) and in the 33% cases (n = 10) it was anterior. The mean Lysholm score improved from 74.6 preoperative to 93.17 postoperative with no objective evidence of laxity.

Conclusion: The free hand trans-tibial creation of the femoral tunnel leads to satisfactory coronal obliquity, but it is difficult to recreate anatomic femoral tunnel by this method as the tunnel is consistently anterior in the sagittal plane.

Keywords: ACL reconstruction; Femoral tunnel; Knee; anterior cruciate ligament; anterior cruciate ligament reconstruction; arthroscopy; single bundle; trans-tibial.

Conflict of interest statement

Conflict of Interest: None.


Figure 1
Figure 1
Arthroscopic picture showing trans-tibial guide wire
Figure 2
Figure 2
Arthroscopic picture showing guide wire with improved coronal angulation
Figure 3
Figure 3
Postoperative X-ray of knee joint anteroposterior and lateral views showing femoral tunnel angle in coronal plane and sagittal location
Figure 4
Figure 4
A line diagram of femoral footprint showing anterior cruciate ligament

Similar articles

See all similar articles

Cited by 3 PubMed Central articles


    1. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’ clock and 10 o’clock femoral tunnel placement 2002 Richard O’Connor Award paper. Arthroscopy. 2003;19:297–304. - PubMed
    1. Stanford FC, Kendoff D, Warren RF, Pearle AD. Native anterior cruciate ligament obliquity versus anterior cruciate ligament graft obliquity: An observational study using navigated measurements. Am J Sports Med. 2009;37:114–9. - PubMed
    1. Heming JF, Rand J, Steiner ME. Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med. 2007;35:1708–15. - PubMed
    1. Piasecki DP, Bach BR, Jr, Espinoza Orias AA, Verma NN. Anterior cruciate ligament reconstruction: Can anatomic femoral placement be achieved with a transtibial technique? Am J Sports Med. 2011;39:1306–15. - PubMed
    1. Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM. The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med. 2001;29:567–74. - PubMed

LinkOut - more resources