Fatih Emre TOPSAKAL, Emre GÜLTAÇ, Cem Yalın KILINÇ, Fatih İlker CAN, Hıdır TANYILDIZI, Çağatay GEMCİ, Nevres Hürriyet AYDOĞAN
Joint Diseases and Related Surgery - 2026;37(1):107-116
Objectives: The aim of this study was to compare the radiological and functional results of femoral tunnels created in Figure-4 and 110 derece 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 derece 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 derece 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). 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.
