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Femoral tunnel is too posterior
9%
300/3349
Femoral tunnel is too anterior
72%
2399/3349
Femoral tunnel placed at 12:00 position
4%
135/3349
Tibial tunnel is too anterior
14%
454/3349
Tibial tunnel is too medial
1%
30/3349
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The majority of early ACL reconstruction failures are felt to be due to errors in surgical technique. The most common error in ACL reconstruction is aberrant tunnel placement. The femoral tunnel can be placed too anteriorly, thereby causing increased strain on the graft in flexion because of the cam effect of the femoral condyle which can result in graft stretching, laxity in extension, and subsequent failure. Chhabra et al. performed a cadaveric study to demonstrate the anatomic footprints of the anteromedial and posterolateral bundles of the ACL. Markhof et al. performed a cadaveric study analyzing the effects of aberrant placement of the femoral tunnel. Illustration A is a table demonstrating the effects of tunnel malposition. Illustrations B and C are gross anatomy illustrations of normal ACL anatomy.
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