Abstract

The effect of tibial and femoral graft placement on radiographic laxity after anterior cruciate ligament reconstruction was studied in 90 knees. All the knees were operated according to the Marshall-MacIntosh procedure with a through-the-condyle technique. Graft position and laxity were determined on lateral x-rays (static and mechanically assisted 200 Newtons anterior drawer strain). No relation was observed between tibial tunnel position and radiographic laxity. In fact few variations in placement were recorded. Femoral tunnel placement was more dispersed, and it strongly influenced the radiographic laxity (p = 0.0001). Laxity was minimal when the center of the femoral tunnel was 6 mm below the intercondylar notch roof and 2.5 mm behind the posterior margin of the notch. No correlations were observed between tunnel positions and function evaluated with the ARPEGE score. These results stressed the importance of the femoral graft placement to control laxity after anterior cruciate ligament reconstruction, and allowed determination in vivo of a position for which minimal laxity could be expected. Since the method determining the femoral graft placement in the present study was not precise, we now use fluoroscopic control to determine drill-guide position.