ArticleJoint diseases and related surgery2026
Comparisons of the radiological and functional results of femoral tunnels created in Figure-4 and 110° flexion positions in arthroscopic anterior cruciate ligament reconstruction.
Article in Joint diseases and related surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe aim of this study was to compare the radiological and functional results of femoral tunnels created in Figure-4 and 110° flexion positions in anterior cruciate ligament (ACL) reconstruction. PATIENTS AND
methodsBetween January 2016 and December 2019, a total of 84 patients (78 males, 6 females; mean age: 29.2±6.1 years; range, 17 to 46 years) who underwent anatomic ACL reconstruction (ACLR) were retrospectively analyzed. The patients were divided into two groups according to femoral tunnel drilling technique: 110° knee flexion (Group 1) and the Figure-4 position (Group 2). Demographic data were recorded. Radiological measurements (femoral tunnel position, length, angles, and distances to the lateral epicondyle) were performed on postoperative Day 1 computed tomography (CT) scans. Functional scores (Lysholm, Cincinnati, IKDC-SKF, Tampa Kinesiophobia, Return to Sport) were assessed at 12 months postoperatively. Radiological and functional outcomes were compared between groups.
resultsThe mean anterior distance and axial tunnel angle were higher in the 110° flexion group than in the Figure-4 group (AD: p=0.001; ATA: p=0.035). The superior distance, femoral tunnel length, coronal tunnel angle, and femoral tunnel positioning measurements were significantly higher in the Figure-4 group (SD: p=0.001; FTL: p=0.006; CTA: p=0.001; FTP deep-shallow: p=0.001; FTP high-low: p=0.001). The Cincinnati Knee Rating System scores were also significantly higher in the Figure-4 group (p=0.001).
conclusionAnterior cruciate ligament reconstruction using the Figure-4 method provides satisfactory and comparable results with the conventional method. The Figure-4 position allows for 130 to 140º flexion of the knee and tunneling closer to the anatomical ACL insertion owing to the ease of application without creating any operational difficulties.
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