Technical errors are often cited as the leading cause of anterior cruciate ligament reconstruction (ACLR) failure. The most common technical error is nonanatomic tunnel placement with failure to reconstitute rotational stability. Historical techniques placed the femoral tunnel high and medial within the intercondylar notch. This reconstruction resulted in stability of the knee in the sagittal plane and reduction of laxity on Lachman testing. However, recent anatomic studies have shown that femoral tunnels placed in this location (11-o’clock position in a right knee) are nonanatomic and may not reconstitute rotational stability. Failure to eliminate the pivot-shift phenomenon results in continued clinical instability and may also increase the risk of graft failure. Clinical instability with pivot-shift testing has been shown to be the best predictor of postoperative patient dissatisfaction.
Failure to anatomically reconstruct the femoral footprint can lead to rotational instability and clinical failure. This study sought to compare femoral tunnel drilling techniques, specifically anteromedial (AM) and transtibial (TT) methods, with respect to rotational stability.