Comparisons of the radiological and functional results of femoral tunnels created in Figure-4 and 110° flexion positions in arthroscopic anterior cruciate ligament reconstruction
Fatih Emre Topsakal1
, Emre Gültaç2, Cem Yalın Kılınç3, Fatih İlker Can4, Hıdır Tanyıldızı5, Çağatay Gemci6, Nevres Hürriyet Aydoğan2
1Department of Orthopedics and Traumatology, Erzurum City Hospital, Erzurum, Türkiye
2Department of Orthopedics and Traumatology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Türkiye
3Private Clinic of Orthopedics and Traumatology, Muğla, Türkiye
4Department of Orthopedics and Traumatology, Muğla Training and Research Hospital, Muğla, Türkiye
5Merkez Prime Hospital Clinic of Orthopedics and Traumatology, Kocaeli, Türkiye
6Department of Orthopedics and Traumatology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye
Keywords: Anterior cruciate ligament reconstruction, arthroscopic, femoral tunneling position, Figure-4 position, 110° flexion position, radiological and functional results.
Abstract
Objectives: The 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 methods: Between 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.
Results: The 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 highlow: p=0.001). The Cincinnati Knee Rating System scores were also significantly higher in the Figure-4 group (p=0.001).
Conclusion: Anterior 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.
Citation: Topsakal FE, Gültaç E, Kılınç CY, Can Fİ, Tanyıldızı H, Gemci Ç, et al. Comparisons of the radiological and functional results of femoral tunnels created in Figure-4 and 110° flexion positions in arthroscopic anterior cruciate ligament reconstruction. Jt Dis Relat Surg 2026;37(1):i-x. doi: 10.52312/jdrs.2026.2288.