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CT-Based Tunnel Position Analysis and its Correlation with Residual Instability after Anterior Cruciate Ligament Reconstruction.

Baskar US, Nayak ST, Selvaraj NV, Senthilnathan PG, Prakash S, Patil H. · Journal of orthopaedic case reports · 2026

Researchers used post-surgery CT scans of 50 people who had ACL reconstruction to check exactly where the surgeon drilled the bone tunnels in the thigh bone and shin bone, then tested each knee for looseness. About 36% still had some instability, and poorly placed tunnels — especially on the femoral (thigh) side — were much more common in those unstable knees, with both tunnels misplaced being the worst case.
Takeaway: If you're facing ACL reconstruction, ask your surgeon about their technique for anatomic tunnel placement, since it strongly influences whether the knee feels stable afterward.
Abstract (source)

Introduction: Anterior cruciate ligament (ACL) reconstruction

Aims: to restore knee stability, but improper femoral and tibial tunnel placement can lead to persistent instability. Computed tomography (CT)-based 3D assessment helps correlate tunnel position with outcomes.

Materials and methods: A study of 50 patients undergoing primary arthroscopic ACL reconstruction used post-operative CT to assess tunnel placement relative to anatomical landmarks. Knee stability was evaluated using Lachman and pivot shift tests, and patients were grouped by residual instability.

Results: Residual instability occurred in 36% of patients. Anatomical femoral and tibial tunnel placement was achieved in 62% and 68% of cases, respectively. Non-anatomical femoral (66.7%) and tibial (55.6%) tunnels were more common in unstable knees, with combined malposition showing the highest instability rates.

Conclusion: Non-anatomical tunnel placement, especially femoral, is strongly associated with residual instability, emphasizing the importance of precise anatomical positioning in ACL reconstruction.

Primary studyInjury Prevention & Rehab
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