Surgical treatment of anterior cruciate ligament (ACL) surgery has been through major changes the last decade. The formerly dominant technique, transtibial approach for ACL reconstruction, has – due to new insights in the functional anatomy of the knee – been replaced with the so-called “anatomic” approach for ACL reconstruction. Even though the new technique has been shown to give superior stability – the number of ACL revisions (new ACL reconstructions to same knee) has been doubled after this major change of techniques.

The first part of our project was to make a long-term evaluation of the transtibial ACL approach. At minimum 10 years after surgery 96 patients were therefore invited to a clinical and radiological evaluation by an independent examiner. The over-all clinical outcome as well as outcomes related to radiologically assessed graft tunnel placement was evaluated in the group.

The second part of our project did involve a cohort of patients treated by a surgeon changing from the transtibial to the “anatomic” approach to ACL reconstruction. Based on a theory that unwanted variability in femoral graft tunnel placement was an important reason for early failure of this new ACL technique – postoperative 3D CT has been done in a cohort of 172 patients with the intention of evaluating the femoral graft tunnel. Feedback on tunnel placement has been given to the surgeon, and the effect of the feedback was evaluated by distance (with time) from a given femoral anatomical centre for the anterior cruciate ligament.