{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:05:37Z","timestamp":1789211137679,"version":"build-2803163510"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy, Sports Medicine, and Rehabil."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare clinical outcomes and graft failure between anatomical femoral tunnel (FT) placement at the central and anteromedial bundle (AMB) positions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines. A search of PubMed, Cochrane, and Web of Science in November 2024 identified studies comparing AMB and central FT placement in anatomical single\u2010bundle anterior cruciate ligament reconstruction. The risk of bias was assessed using the Risk Of Bias in Non\u2010randomized Studies of Interventions tool. A qualitative synthesis was performed and presented graphically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six studies with 841 patients (444 AMB FT, 397 central FT) were included. Weighted mean follow\u2010up was 34.8 and 40.7\u2009months for the AMB and central groups, respectively. Overall risk of bias was serious in 4 studies and moderate in 2. AMB FT placement was associated with a significantly lower risk of graft failure (74%\u201077% reduction) in 2 studies. However, concerns in risk of bias and consistency decreased the certainty in this finding. Evidence for patient\u2010reported outcomes and anterior stability was mixed and of uncertain clinical importance. Although some studies reported statistically significant benefits for AMB FT placement (differences of &lt;7 points for patient\u2010reported outcomes and &lt;1\u2009mm for anterior stability), others found no significant difference. Rotational laxity showed a nonsignificant difference between groups in all studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The current evidence is limited by methodological flaws and risk of bias. It suggests that AM FT placement might be associated with a lower risk of graft failure compared with central placement. The AM position might achieve better patient\u2010reported outcomes and anterior stability, although the difference is not clinically significant. No evidence of a difference was found regarding rotational stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level III, systematic review of Level II and III studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ars2.70075","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T10:11:50Z","timestamp":1789207910000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anteromedial Femoral Tunnel Placement Reduces Graft Failure Risk Without Affecting Rotational Stability in Anatomic Single\u2010Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5466-5601","authenticated-orcid":false,"given":"Haitham Kamel","family":"Haroun","sequence":"first","affiliation":[{"name":"Orthopedic Department Faculty of Medicine Ain Shams University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4772-5263","authenticated-orcid":false,"given":"Amr Mohamed","family":"Abdelhady","sequence":"additional","affiliation":[{"name":"Orthopedic Department Faculty of Medicine Ain Shams University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abdallah","family":"Obied","sequence":"additional","affiliation":[{"name":"Orthopedic Department Faculty of Medicine Ain Shams University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5543-4971","authenticated-orcid":false,"given":"Mostafa Aly","family":"Elabd","sequence":"additional","affiliation":[{"name":"Orthopedic Department Faculty of Medicine Ain Shams University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1302\/0301-620X.98B8.37117","article-title":"The anatomy of the anterior cruciate ligament and its relevance to the technique of reconstruction","volume":"98","author":"Smigielski R","year":"2016","journal-title":"Bone Joint J."},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1007\/s00167-011-1851-z","article-title":"Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study","volume":"20","author":"Kopf S","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"232596712110245","DOI":"10.1177\/23259671211024591","article-title":"Clinical and radiological outcomes of anteromedial portal versus transtibial technique in ACL reconstruction: A systematic review","volume":"9","author":"Loucas M","year":"2021","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.jisako.2022.11.001","article-title":"Rebranding the \u2018Anatomic\u2019 ACL reconstruction: Current concepts","volume":"8","author":"Borque KA","year":"2023","journal-title":"J ISAKOS."},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1007\/s00167-011-1737-0","article-title":"Anteromedial versus central single\u2010bundle graft position: Which anatomic graft position to choose?","volume":"20","author":"Cross MB","year":"2012","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_7_1","first-page":"232596712110018","article-title":"Creating a femoral tunnel aperture at the anteromedial footprint versus the central footprint in ACL reconstruction: Comparison of contact stress patterns","volume":"9","author":"Kim SJ","year":"2021","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_8_1","first-page":"253","article-title":"Rationale for strategic graft placement in anterior cruciate ligament reconstruction: I.D.E.A.L. femoral tunnel position","volume":"44","author":"Pearle AD","year":"2015","journal-title":"Am J Orthop (Belle Mead NJ)."},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1007\/s00167-013-2694-6","article-title":"Anatomic ACL reconstruction produces greater graft length change during knee range\u2010of\u2010motion than transtibial technique","volume":"22","author":"Lubowitz JH","year":"2014","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"3143","DOI":"10.1007\/s00167-014-3146-7","article-title":"Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: A cadaveric study including 111 knees","volume":"23","author":"Smigielski R","year":"2015","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.arthro.2011.12.021","article-title":"The femoral insertion of the anterior cruciate ligament: Discrepancy between macroscopic and histological observations","volume":"28","author":"Sasaki N","year":"2012","journal-title":"Arthroscopy."},{"key":"e_1_2_8_12_1","first-page":"11","article-title":"Anteromedial positioning of the femoral tunnel in anterior cruciate ligament reconstruction is the best option to avoid revision: A single surgeon registry","volume":"7","author":"Cury RDL","year":"2020","journal-title":"J\u00a0Exp Orthop."},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"e000420","DOI":"10.1136\/bmjsem-2018-000420","article-title":"Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: Functional anatomical reconstruction","volume":"4","author":"Jorge PB","year":"2018","journal-title":"BMJ Open Sport Exerc Med."},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1055\/s-0040-1710521","article-title":"Systematic review of surgical technique and tunnel target points and placement in anatomical single\u2010bundle ACL reconstruction","volume":"34","author":"Iriuchishima T","year":"2021","journal-title":"J Knee Surg."},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1053\/jars.2003.50084","article-title":"Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O\u2019Connor Award paper","volume":"19","author":"Loh JC","year":"2003","journal-title":"Arthroscopy."},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1177\/0363546504271747","article-title":"Varying femoral tunnels between the anatomical footprint and isometric positions \u2010 Effect on kinematics of the anterior cruciate ligament\u2010reconstructed knee","volume":"33","author":"Musahl V","year":"2005","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1177\/0363546506294571","article-title":"The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation","volume":"35","author":"Zantop T","year":"2007","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1177\/0363546508315536","article-title":"Comparison of 3\u2010dimensional obliquity and anisometric characteristics of anterior cruciate ligament graft positions using surgical navigation","volume":"36","author":"Pearle AD","year":"2008","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"e268195","DOI":"10.1590\/1413-785220233104e268195","article-title":"Anteromedial or central anatomic acl reconstruction? A cadaveric hip\u2010to\u2010toe study","volume":"31","author":"Fernandes TL","year":"2023","journal-title":"Acta Ortopedica Brasileira."},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.arthro.2014.08.033","article-title":"The role of fibers in the femoral attachment of the anterior cruciate ligament in resisting tibial displacement","volume":"31","author":"Kawaguchi Y","year":"2015","journal-title":"Arthroscopy."},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1007\/s00167-012-1951-4","article-title":"Biomechanical comparison of different graft positions for single\u2010bundle anterior cruciate ligament reconstruction","volume":"21","author":"Kato Y","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_22_1","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1177\/0363546509358321","article-title":"A comparison of 11 o'clock versus oblique femoral tunnels in the anterior cruciate ligament\u2010reconstructed knee: Knee kinematics during a simulated pivot test","volume":"38","author":"Markolf KL","year":"2010","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_23_1","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1016\/j.arthro.2010.01.028","article-title":"Comparing stability of different single\u2010 and double\u2010bundle anterior cruciate ligament reconstruction techniques: A cadaveric study using navigation","volume":"26","author":"Musahl V","year":"2010","journal-title":"Arthroscopy."},{"key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.2106\/JBJS.16.00241","article-title":"The relationship between ACL femoral tunnel position and postoperative MRI signal intensity","volume":"99","author":"Lee SM","year":"2017","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_8_25_1","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1007\/s00167-020-06206-y","article-title":"No differences in clinical outcomes and graft healing between anteromedial and central femoral tunnel placement after single bundle ACL reconstruction","volume":"29","author":"Zhang J","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s00167-018-5036-x","article-title":"Transportal central femoral tunnel placement has a significantly higher revision rate than transtibial AM femoral tunnel placement in hamstring ACL reconstruction","volume":"27","author":"Clatworthy M","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1007\/s00167-021-06765-8","article-title":"Factors affecting return to play and graft re\u2010rupture after primary ACL reconstruction in professional footballers","volume":"30","author":"Balendra G","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_28_1","doi-asserted-by":"crossref","first-page":"2780","DOI":"10.1002\/ksa.12300","article-title":"Nonanatomic femoral tunnel placement increases the risk of subsequent meniscal surgery after ACLR: Part II\u2010Patients without recurrent ACL injury","volume":"32","author":"Inoue J","year":"2024","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_29_1","doi-asserted-by":"crossref","first-page":"2180","DOI":"10.1177\/0363546516673984","article-title":"The anatomic centers of the femoral and Tibial insertions of the anterior cruciate ligament: A systematic review of imaging and cadaveric studies reporting normal center locations","volume":"45","author":"Parkar AP","year":"2017","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_30_1","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS\u2010I: A tool for assessing risk of bias in non\u2010randomised studies of interventions","volume":"355","author":"Sterne JA","year":"2016","journal-title":"BMJ."},{"key":"e_1_2_8_31_1","doi-asserted-by":"crossref","first-page":"3126","DOI":"10.1016\/j.arthro.2018.10.005","article-title":"Reviews pooling heterogeneous, low\u2010evidence, high\u2010bias data result in incorrect conclusions: But heterogeneity is an opportunity to explore","volume":"34","author":"Cote MP","year":"2018","journal-title":"Arthroscopy."},{"key":"e_1_2_8_32_1","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1016\/j.knee.2018.08.007","article-title":"Mid\u2010bundle positioning of the femoral socket increases graft rupture in anatomic single bundle anterior cruciate ligament reconstruction","volume":"25","author":"Borton ZM","year":"2018","journal-title":"Knee."},{"key":"e_1_2_8_33_1","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1016\/j.arthro.2018.11.055","article-title":"Effect of femoral tunnel position on stability and clinical outcomes after single\u2010bundle anterior cruciate ligament reconstruction using the outside\u2010in technique","volume":"35","author":"Seo SS","year":"2019","journal-title":"Arthroscopy."},{"key":"e_1_2_8_34_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.knee.2022.02.010","article-title":"Failure rate analysis and clinical outcomes of two different femoral tunnel positions using anteromedial portal technique in anterior cruciate ligament reconstruction","volume":"35","author":"Tecame A","year":"2022","journal-title":"Knee."},{"key":"e_1_2_8_35_1","doi-asserted-by":"crossref","first-page":"e15898","DOI":"10.7717\/peerj.15898","article-title":"High anteromedial insertion reduced anteroposterior and rotational knee laxity on mid\u2010term follow\u2010up after anatomic anterior cruciate ligament reconstruction","volume":"11","author":"Zhang X","year":"2023","journal-title":"PeerJ."},{"key":"e_1_2_8_36_1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1007\/s43465-021-00485-4","article-title":"How important is the tunnel position in outcomes post\u2010ACL reconstruction: A 3D CT\u2010based study","volume":"56","author":"Mhaskar VA","year":"2022","journal-title":"Indian J Orthop."},{"key":"e_1_2_8_37_1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1177\/036354659602400315","article-title":"The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction","volume":"24","author":"Khalfayan EE","year":"1996","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_38_1","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s00167-007-0295-y","article-title":"The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: A prospective study","volume":"15","author":"Moisala AS","year":"2007","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_39_1","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1007\/s00167-021-06654-0","article-title":"Graft isometry during anatomical ACL reconstruction has little effect on surgical outcomes","volume":"30","author":"Moon HS","year":"2022","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_40_1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/0363546510377417","article-title":"In vivo stability and clinical comparison of anterior cruciate ligament reconstruction using low or high femoral tunnel positions","volume":"39","author":"Seon JK","year":"2011","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_41_1","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.2106\/JBJS.H.00940","article-title":"Effect of femoral tunnel placement for reconstruction of the anterior cruciate ligament on tibial rotation","volume":"91","author":"Ristanis S","year":"2009","journal-title":"J Bone Joint Surg Am."},{"key":"e_1_2_8_42_1","first-page":"419","article-title":"Comparison of clinical outcomes between different femoral tunnel positions after anterior cruciate ligament reconstruction surgery","volume":"5","author":"Kazemi SM","year":"2017","journal-title":"Arch Bone Jt Surg."},{"key":"e_1_2_8_43_1","first-page":"232596712110699","article-title":"Ideal combination of anatomic tibial and femoral tunnel positions for single\u2010bundle ACL reconstruction","volume":"10","author":"Yoon KH","year":"2022","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_44_1","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1177\/03635465211025003","article-title":"Neither residual anterior knee laxity up to 6 mm nor a pivot glide predict patient\u2010reported outcome scores or subsequent knee surgery between 2 and 6 years after ACL reconstruction","volume":"49","author":"Magnussen RA","year":"2021","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_45_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF00182976","article-title":"The measurement of anterior cruciate ligament strain in vivo","volume":"16","author":"Beynnon B","year":"1992","journal-title":"Int Orthop."},{"key":"e_1_2_8_46_1","first-page":"201","article-title":"Anterior cruciate ligament reconstruction stability with continuous passive motion. The role of isometric graft placement","volume":"277","author":"O\u2019Meara PM","year":"1992","journal-title":"Clin Orthop Relat Res."},{"key":"e_1_2_8_47_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.5435\/00124635-200901000-00005","article-title":"Knee injury outcomes measures","volume":"17","author":"Wright RW","year":"2009","journal-title":"J Am Acad Orthop Surg."},{"key":"e_1_2_8_48_1","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1111\/os.12791","article-title":"Clinical outcome of remnant\u2010preserving and I.D.E.A.L. femoral tunnel technique for anterior cruciate ligament reconstruction","volume":"12","author":"Su C","year":"2020","journal-title":"Orthop Surg."},{"key":"e_1_2_8_49_1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s00167-010-1222-1","article-title":"A long journey to be anatomic","volume":"18","author":"Fu FH","year":"2010","journal-title":"Knee Surg Sports Traumatol Arthrosc."}],"container-title":["Arthroscopy, Sports Medicine, and Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ars2.70075","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ars2.70075","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ars2.70075","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T10:11:57Z","timestamp":1789207917000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ars2.70075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,12]]},"references-count":48,"alternative-id":["10.1002\/ars2.70075"],"URL":"https:\/\/doi.org\/10.1002\/ars2.70075","archive":["Portico"],"relation":{},"ISSN":["2666-061X","2666-061X"],"issn-type":[{"value":"2666-061X","type":"print"},{"value":"2666-061X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,12]]},"assertion":[{"value":"2025-10-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70075"}}