Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 9, pp 1189–1194 | Cite as

Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem?

  • Alcindo SilvaEmail author
  • Ricardo Sampaio
  • Elisabete Pinto


Tunnel enlargement after anterior cruciate ligament (ACL) reconstruction may compromise revision surgery. The cause of this tunnel enlargement is not yet fully understood, but it is thought to be multifactorial, with biomechanical and biological factors playing a role. Tunnel enlargement has been described particularly in patients who underwent ACL reconstruction with hamstring tendons with extracortical fixation devices. The purpose of our study was to evaluate prospectively with magnetic resonance imaging (MRI) the changes in femoral tunnel diameter following arthroscopic anatomic ACL reconstruction with hamstring tendons. At 3-month post-op, all tunnels had enlarged compared to the diameter of the drill and most tunnels enlarged more in the midsection than at the aperture. In the posterolateral tunnels, the entrance increased 16% in diameter and the middle of the tunnel increased 30% in diameter. In the anteromedial femoral tunnels, the tunnels enlarged 14% at the aperture and 35% in the midsection. All femoral tunnels enlarged and most of them enlarged in a fusiform manner. The biological factors explain better our findings than the mechanical theory, although mechanical factors may play a role and the cortical bone at the entrance of the tunnel may modify the way tunnels respond to mechanical stress.


Anterior cruciate ligament Anatomic reconstruction Tunnel enlargement Tunnel widening 


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Alcindo Silva
    • 1
    Email author
  • Ricardo Sampaio
    • 2
  • Elisabete Pinto
    • 3
  1. 1.Military Hospital D. Pedro VPortoPortugal
  2. 2.Instituto CufPortoPortugal
  3. 3.Department of Hygiene and EpidemiologyMedical School of University of PortoPortoPortugal

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