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Lateral location of the tibial tunnel increases lateral meniscal extrusion after anatomical single-bundle anterior cruciate ligament reconstruction
  1. Takeshi Oshima,
  2. Samuel Grasso,
  3. Aaron Beach,
  4. Brett Fritsch,
  5. David A Parker
  1. Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
  1. Correspondence to Dr Takeshi Oshima, Sydney Orthopaedic Research Institute, The Gallery, 445 Victoria Avenue, Chatswood, NSW 2067, Australia; shimashima10292000{at}


Introduction The tibial footprint of the anterior cruciate ligament (ACL) overlaps with the anterior lateral meniscal root (ALMR), and there is a possibility that an anatomical tibial tunnel reaming might damage the attachment of ALMR. The aim of this study was to investigate the relationship between tibial tunnel location and lateral meniscal extrusion (LME) after anatomical single-bundle ACL reconstruction.

Methods A prospectively collected database and associated intraoperative findings for 153 patients undergoing primary anatomical ACL reconstruction between October 2014 and July 2016 were investigated. Those cases with no meniscal injury seen at surgery and meeting the criteria (52/153) were included. Tibial plateau length (TPL), width (TPW), tibial tunnel location and LME were evaluated from postoperative high-resolution MRI. The location of the centre of the tibial tunnel was evaluated by the position relative to the medial tibial eminence with two measures, the medial–lateral distance (MLD) and anterior–posterior distance. These measures were expressed as a percentage of the TPW and TPL, respectively. The LME was also expressed as a percentage of TPW and correlated with tibial tunnel location.

Results There was a positive correlation between percentage of LME (%LME) and percentage of MLD (%MLD) (r=0.478; p<0.001). Applying receiver operating characteristic analysis, we determined that a cut-off value of 4 %MLD was significant. The mean percentage of LME was 1.20 for >4 %MLD, compared with 0.17 for ≤4 %MLD (p<0.001). No significant correlation was found between %LME and clinical outcomes at 1-year follow-up.

Conclusion Lateral location of the tibial tunnel increases the rate of LME after single-bundle ACL reconstruction.

Level of evidence Level IV, Case series.

  • Anterior cruciate ligament
  • Anterolateral meniscal root
  • Lateral meniscal extrusion
  • Tibial tunnel
  • Reconstruction
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  • Contributors Conceptualisation: TO. Project administration and supervision: DAP and BF. Investigation, formal analysis and validation: TO, SG and AB. Writing—original draft: TO. Writing—review and editing: AB and DAP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Ethical approval for the present study was granted from the local ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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