Abstract
The impact of primary femoral tunnel position on rerupture rates following revision
anterior cruciate ligament reconstruction (ACLR) remains unclear. This study aimed
to explore whether the anatomical placement of the primary femoral tunnel affects
rerupture risk, tunnel positioning at revision surgery, and postoperative clinical
outcomes. Among 165 patients who underwent revision ACLR at our institution between
2018 and 2022, 78 cases with a minimum of 2 years of follow-up were included. The
primary femoral tunnel position was evaluated using Bernard and Hertel's quadrant
method on 3D CT scans. Patients were categorized into group A (anatomical position)
and group N (nonanatomical position). Rerupture rate, tunnel position at revision
ACLR, and clinical outcomes were compared between the groups. Subgroup analyses were
conducted based on primary surgical technique (single-bundle [SB] vs. double-bundle
[DB]). Additionally, multivariate logistic regression analysis was performed to identify
independent predictors of rerupture. Rerupture occurred in three of 39 cases (7.7%)
in group A and six of 39 cases (15.4%) in group N (p = 0.48). There were no significant differences in age, sex, height, weight, sports
type, or posterior tibial slope. Anatomical tunnel placement at revision was achieved
in 94.9% of group A and 79.5% of group N (p = 0.087). No significant differences in Knee Injury and Osteoarthritis Outcome Score
or ACL-return to sport after injury scale were observed at 2 years postoperatively.
Subgroup analysis based on primary surgical technique (SB vs. DB) revealed no significant
differences in rerupture rates or femoral tunnel positioning at revision. Multivariate
logistic regression identified anatomical tunnel placement during the revision surgery
as the only independent protective factor against rerupture (odds ratio: 0.145; 95%
confidence interval: 0.022–0.951; p = 0.044). Anatomical tunnel placement during primary ACLR appears to be a key factor
associated with a reduced risk of rerupture following revision ACLR. These exploratory
findings underscore the importance of accurate tunnel positioning and should be interpreted
cautiously due to the limited sample size.
Level of Evidence Level III.
Keywords
revision surgery - anterior cruciate ligament - anatomical position - femoral tunnel
