Coronal tibial anteromedial tunnel location has minimal effect on knee biomechanics

  • Shigehiro Asai
  • Donghwi Kim
  • Yuichi Hoshino
  • Chan-Woong Moon
  • Akira Maeyama
  • Monica Linde
  • Patrick Smolinski
  • Freddie H. Fu



Studies have found anatomic variation in the coronal position of the insertion site of anteromedial (AM) bundle of the anterior cruciate ligament (ACL) on the tibia, which can lead to questions about tunnel placement during ACL reconstruction. The purpose of this study was to determine how mediolateral placement of the tibial AM graft tunnel in double-bundle ACL reconstructions affects knee biomechanics.


Two different types of double-bundle ACL reconstructions were performed. The AM tibial tunnel was placed at either the medial or lateral portion of tibial AM footprint. Nine cadaveric knees were tested with the robotic/universal force-moment sensor system with the use of (1) an 89.0-N anterior tibial load at full extension (FE), 30°, 60° and 90° of knee flexion and (2) a combined 7.0-Nm valgus torque and 5.0-Nm internal tibial rotation torque at FE, 15°, 30°and 45° of knee flexion.


Both medial (2.6 ± 1.2 mm) and lateral (1.6 ± 0.9 mm) double-bundle reconstructions reduced the anterior tibial translation (ATT) to less than the intact value (3.9 ± 0.7 mm) at FE. At all other flexion angles, there was no significant different in ATT between the intact knee and the reconstructions. At FE, the ATT for the medial AM reconstruction was different from that of the lateral AM construction and closer to the intact ACL value.


The coronal tibial placement of the AM tunnel had only a slight effect on knee biomechanics. In patients with differing AM bundle coronal positions, the AM tibial tunnel can be placed anatomically at the native insertion site.


Coronal tibial AM location ACL reconstruction Double bundle 



The Albert B. Ferguson Jr. MD, Orthopaedic Fund of the Pittsburgh Foundation.


This study was funded by The Albert B. Ferguson Jr. MD, Orthopaedic Fund of the Pittsburgh Foundation Grant and by the Department of Orthopaedic Surgery at the University of Pittsburgh.

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Ethical approval

Approval was required for the use of human cadaver knee specimens at the University of Pittsburgh, CORID 303.

Informed consent



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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Shigehiro Asai
    • 1
  • Donghwi Kim
    • 1
  • Yuichi Hoshino
    • 1
  • Chan-Woong Moon
    • 1
  • Akira Maeyama
    • 1
  • Monica Linde
    • 1
  • Patrick Smolinski
    • 1
    • 2
  • Freddie H. Fu
    • 1
    • 2
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA
  2. 2.Department of Mechanical Engineering and Materials ScienceUniversity of PittsburghPittsburghUSA

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