Effect of femoral tunnel positions on graft stress in outside-in ACL reconstruction surgery during continuous knee motion: A simulation study.

Abstract

Previous studies regarding the optimal femoral tunnel location for an anterior cruciate ligament (ACL) reconstruction were based on static experiments at specific angles, and did not consider continuous motion of the knee. Twenty-four surgical sites were set and continuous kinematic data, obtained from motion analysis, was used to describe knee movement. The bending angle and stress of the ACL graft as well as the length of the femoral tunnel was calculated through multi-flexible body dynamics analysis. The lowest stress was found at both 5mm and 10mm radius at a proximal posterior of 45°, and the highest stress was also found at a distal 15mm radius. Relatively high stresses were also identified between the distal and anterior regions as well as the distal and posterior regions at 15mm radius. Considering the availability of surgery, it was identified that the optimum femoral tunnel location is at 10mm radius locations at a proximal posterior of 45°.