Understanding Tunnel Malposition

🪛Understanding Femur Tunnel Malposition

Femur Tunnel Malposition - No. 1 Cause of Technical Failure

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Femur Tunnel Malposition is leading cause of technical ACL failure (AJSM 2010, MARS Group)

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Femur Tunnel Malposition in Revision ACL Reconstruction (J Knee Surg 2012, Morgan et al.)

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Femur Tunnel Malposition Drives Technical Failure (Arch Orthop Trauma Surg 2018, Jaecker et al.)

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Femur Tunnel Malposition Increases Risk of Revision ACLR (KSSTA 2021, Byrne et al.)

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Femur Tunnel Malpostion Increases Long-Term ACL Failure (KSSTA 2022, de Mees et al.)

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Femur Tunnel Malposition Predicts ACLR Failure (Arthroscopy 2024, Shi et al.)

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Tunnel Malposition in 18.8% of Failed ACL Reconstruction (Medicine 2025, Jin et al.)

Why? High Variability in Femur ACL Footprint

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High Variability of the Femur ACL Center Challenges Surgeons (Knee 2021, Dimitriou et al.)

Why? Surgeons Cannot Identify Femur ACL Footprint Reliably

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Surgeons Cannot Reliably Identify Femur ACL Landmarks on 3D Models (Arthrosc Sports Med Rehabil 2020, Laverdiere et al.)

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3D MRI Shows Surgeons Often Misses the Native Femur Footprint (AJSM 2017, Hart et al.)

“Anatomic” ACL Reconstruction?

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Rebranding the “Anatomic” ACL Reconstruction (J ISAKOS 2023, Borque et al.)

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Isn’t It Time to Stop Pretending Ligament Reconstructions Are “Anatomic”? (Sports Health 2025, Williams & Borque)

Solution: Consider Rizzoli OTT

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👉 “No femur tunnel. No malposition. No tunnel-driven failure.” (Arthroscopy 2024, Lucidi et al.)