Tibial bone tunnel placement in double-bundle anterior cruciate ligament reconstruction using hamstring tendons

Abstract

There have been many discussions about the femoral tunnel positions during double-bundle anterior cruciate ligament (ACL) reconstruction, and several authors have reported that the femoral ACL attachment was behind the "resident’s ridge" and that femoral tunnels should be created behind that ridge. On the other hand, the tibial ACL attachment is variable. Bedi et al. reported that the over-thetop and anterior tibial tunnel positions provided good control in the Lachman test and the pivot shift test compared with posterior tibial tunnel positions. However, the over-the-top tibial tunnel position may cause roof impingement, so a landmark for the anterior border of the tibial tunnels is needed. We reported that the transverse ligament and Parsons’ knob are useful as anterior landmarks for tibial sagittal insertions of anteromedial (AM) tunnels. The tibial intertubercular ridge is useful as a posterior landmark for tibial sagittal insertions of posterolateral (PL) tunnels. Furthermore, the medial intercondylar ridge is useful as a medial landmark for insertions of both tunnels. In this chapter, we introduce the technique of arthroscopic anatomical double-bundle ACL reconstruction, focusing on tibial tunnel creation in particular.