Anatomic Placement of the Femoral Tunnels in Double-Bundle Anterior Cruciate Ligament Reconstruction Correlates With Improved Graft Maturation and Clinical Outcomes

Purpose: To compare maturation of reconstructed graft on second-look arthroscopy and clinical outcomes between 2 groups: the provisional anatomic (PA) group, with both the anteromedial (AM) and posterolateral (PL) femoral tunnels in their anatomic location, and the nonanatomic (NA) group, with either 1 of the 2 femoral tunnels beyond its anatomic location after double-bundle anterior cruciate ligament reconstruction. Methods: We enrolled 154 patients who underwent 3-dimensional computed tomography scanning and second-look arthroscopy after double-bundle anterior cruciate ligament reconstruction. All of the patients were divided into the PA and NA groups according to the femoral tunnel position determined by the quadrant method. Graft maturation was evaluated with 3 subsections, including integrity, tension, and synovial coverage with revascularization, on second-look arthroscopy. We also compared Lachman test, pivot-shift test, KT-2000 (MEDmetric, San Diego, CA), and International Knee Documentation Committee grades at the last follow-up. Results: Of the 154 patients, 88 were classified as the PA group and 66 as the NA group by the quadrant method. A difference existed between groups for the AM tunnel position but not for the PL tunnel position. The PA group showed a higher graft maturation score (P < .001 for all comparisons) and better results according to the International Knee Documentation Committee knee rating, Lachman test, pivot-shift test, and KT-2000 assessment (P < .001 for all comparisons). Conclusions: The PA group with anatomic femoral tunnel placement showed a higher graft maturation score on second-look arthroscopy, along with better clinical outcomes, than the NA group. There was a significant difference in the AM femoral tunnel position but not in the PL tunnel position between the 2 groups.