(Fig 2-D.04) Restricted Range of Motion Caused by Femoral Tunnel

https://youtu.be/qrsWzi0BBxQ

https://youtu.be/rbdodKV6lpE

1️⃣ Assessing Femoral Tunnel Placement

✅ The position of the femoral tunnel can be assessed in the sagittal plane by drawing a line along the posterior cortex of the femur and another line along the roof of the intercondylar notch.

✅ Ideal Tunnel Location: The inferior portion of the tunnel should be located at the intersection of these two lines.

AJR 2010; 194:476–484

 

2️⃣ Bernard and Hertel Grid: Understanding Femoral Tunnel Placement

✅The femoral tunnel placement is reported as two ratios and is commonly referred to as the “Bernard and Hertel grid”.

• A more recent study reported a mean across anatomical studies of 27% in the deep-shallow direction and 34% in the high-low direction.

Skeletal Radiol (2013) 42:1489–1500

 

✅Importance of Single-Bundle Graft Placement

• The single-bundle graft has to provide both anterior-posterior and rotational (pivotal) stability.
• The optimal placement is within the anatomic footprint.
• Deviations from the optimum may result in instability during range of motion, loss of range of motion, and predispose to re-rupture.

 

3️⃣ Restricted range of motion (Tunnel malposition)

☆ Femoral tunnel:

• ✔ too anterior—tight in flexion,
• ✔ too posterior—tight in extension

 

☆ Tibial tunnel:

• ✔ too anterior—limited extension, tight in flexion,
• ✔ too medial/lateral—graft impingement on femoral condyle

Skeletal Radiol. 2022 Jul;51(7):1347-1364

 

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