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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
"Visualizing MSK Radiology: A Practical Guide to Radiology Mastery" © 2022 MSK MRI Jee Eun Lee All Rights Reserved. #VisualizingMSK #ACLinjuries #KneeMRI #ACLtear #femoraltunnel You may not distribute or commercially exploit the content. Nor may you transmit it or store it on any other website or other forms of the electronic retrieval system.
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