| Objective Correct placement of the femoral and tibial bone tunnels is considered the critical approach of the technique for arthroscopic reconstruction of the anterior cruciate ligament(ACL).It will influence clinical outcome directly.We followed up the results of the cases second to arthroscopic ACL reconstruction using central-third,bone-patellar tendon-bone autograft,and measured tunnel placement of the femoral and tibial radiographically.The tunnel position on the different clinical outcome was investigated;the optimal tunnel insertion was discussed consequently.The effect of different times of operation and combined intra-articular injuries were compared and the reasonable project of the treatment was discussed.Methods From March 2004 to August 2006,seventy-nine patients underwent arthroscopic ACL reconstruction using central-third,bone-patellar tendon-bone autograft and interference screw fixation were selected.Sixty-six patients(83.54%)were followed up average eighteen months(6 months to 3 years).Clinical results were rated using the Lysholm score and the Tegner activity level.Fifty-five lateral and AP plane roentgenograms of the extended knee was gained. The location of graft attachment was measured.The femoral tunnel position was confirmed by percentage from the anterior end of Blumensaat's line in the saggital plane,the tibial tunnel position was confirmed by percentage from the anterior edge of the tibia along the tibial plateau in the saggital plane.The position of the tibial intersection of Blumensaat's line was also measured.The patients were divided into better outcome group if their the Lyshoim knee score≥80,and the other as unsatisfactory group.The tunnel position on the different clinical outcome was analyzed statistically.The patients were divided into acute group(within three weeks), subacute group(three weeks to three months)and chronic group(more than three months)or more according times of operation.The short-term results and the proportion of combined intra-articular injuries of different gruops were evaluated.Effects on function of the joint of combined intra-articular injuries were analyzed.Results There was one intra-articular infection.There were no failures of reconstruction or revision ACL reconstruction surgeries.The Lysholm score rose average 41.05±13.83(P＜0.05) and the Tegner activity score rose average 2.56±1.37 at follow-up(P＜0.05).Ten patients (15.15%)had obvious patellofemoral pain at follow-up.There was significant difference(P＜0.05) in femoral attachments of ACL when compared with the different clinical outcome groups.The femoral tunnels of the better outcome group were placed at 67.35±6.55%from the anterior end of Blumensaat's line.There were no differences(P＞0.05)in tibial attachments of ACL and the position of the tibial intersection of Blumensaat's line between these two groups.The study show that the position of tibial tunnel was at 39.77±5.11%of the tibial plateau,behind the position of the tibial intersection of Blumensaat's line.There was no significant difference(P＞0.05)in the Lysholm score and the Tegner activity score between the acute,subacute and chronic group at short-term follow-up.Statistical evaluation showed no significant difference(P＞0.05)for clinical result between group with combined meniscal or medial collateral ligament(MCL)injury and group without injury.Conclusions①The femoral tunnel position influences outcome after anterior cruciate ligament reconstruction,a far too anterior femoral tunnel placement will lead to a decline in the clinical result.The better femoral attachment was located on 65%-69%from the anterior end of the Blumensaat's line.②The position of tibial tunnel was behind the position of the tibial intersection of Blumensaat's line,and was situated on average the front 38%-41%of the tibial plateau.The roentgenograms of the extended knee of preoperation is considered help to locate the tibial tunnel.③There was no difference in the Lysholm score and the Tegner activity score between difference time of operation.The early surgery may protect articular cartilage and reconstruction stability of the knee.
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