A reproducible landmark for the tibial tunnel origin in anterior cruciate ligament reconstruction: Avoiding a vertical graft in the coronal plane

Improper tunnel placement during anterior cruciate ligament reconstruction may result in residual instability. Proper femoral tunnel orientation relies on tibial tunnel placement with a transtibial technique. Our recommended technique is to use the junction of the anterior border of the superficial medial collateral ligament and the superior border of the gracilis tendon as a reproducible anatomic landmark for the tibial tunnel. In a cadaveric model the mean angle for the tibial tunnel was 65.7 degrees +/- 5.5 degrees in the coronal plane and 75 degrees +/- 7.2 degrees in the sagittal plane. By use of the clock-face method, the mean angle for the femoral tunnel was 44.9 degrees +/- 13 degrees, or approximately the 10:30 position (for a right knee) or 1:30 position (for a left knee).