Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 18, Issue 9, pp 1169–1175 | Cite as

What is the role of intra-operative fluoroscopic measurements to determine tibial tunnel placement in anatomical anterior cruciate ligament reconstruction?

  • Philip Kasten
  • Michal Szczodry
  • James Irrgang
  • Eric Kropf
  • Joanna Costello
  • Freddie H. FuEmail author


The hypothesis for this study was that intra-operative fluoroscopic measurements can be used to determine tibial tunnel placement during anatomic anterior cruciate ligament (ACL) reconstruction. The anteromedial (AM) and posterolateral (PL) bundle insertion sites were marked with a thermal device and measured in a consecutive cohort of 67 patients undergoing anatomical ACL reconstruction. For double bundle reconstruction, guide pins were passed in the center of the AM and PL tibial footprints. For single bundle (SB) reconstruction a guide wire was placed between the center of AM and PL footprints. Subsequently, the position of the centers of the AM and PL insertion sites were measured on standardized lateral intra-operative fluoroscopic images. The center for the AM bundle was found to be at 31% (range 20–42%) of the AP distance on the medial joint line and at 35% (range 23–42%) of the AP distance on the Amis and Jakob line. The center of the PL bundle was at 48% (range 37–59%) of the AP distance on the medial joint line and 48% (range 39–58%) of the AP distance on the Amis and Jakob line. The center of the tibial tunnel in the SB group (n = 15) was at 42 and 41% in relation to the medial joint line and the Amis and Jakob line, respectively. Because a significant anatomic variation exists between patients, the decision with respect to tunnel placement should not be merely based on intra-operative fluoroscopic images.


Double bundle Anterior cruciate ligament Reconstruction Fluoroscopy Tibial tunnel position Tibial insertion, radiograph, X-ray image 



This study was not supported by an outside funding or grant. None of the researchers has received (or agreed to receive) from a commercial entity something of value (exceeding the equivalent of US$500) related in any way to this manuscript or research.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Philip Kasten
    • 3
    • 4
  • Michal Szczodry
    • 1
  • James Irrgang
    • 1
  • Eric Kropf
    • 1
  • Joanna Costello
    • 2
  • Freddie H. Fu
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Department of Orthopaedic SurgeryUniversity of DresdenDresdenGermany
  4. 4.Department of Orthopaedic SurgeryUniversity of HeidelbergHeidelbergGermany

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