{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T18:32:51Z","timestamp":1779215571972,"version":"3.51.4"},"reference-count":60,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To investigate the effect that femoral and tibial tunnel positions have on long\u2010term reported and clinical outcome and to identify a safe zone based on favourable outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Seventy\u2010eight patients from a previous randomised controlled trial were included and were followed with a mean follow\u2010up of 11.4 years. All patients had primary trans\u2010tibial anterior cruciate ligament reconstruction performed. The femoral and tibial tunnel positions were visualised and translated in percentages with three\u2010dimensional computed tomography post\u2010operatively. There were 3 separate outcome variables: patient\u2010reported outcome measured with the IKDC Subjective Knee Form, overall failure, and radiographic osteoarthritis. The correlation between tunnel aperture positions and outcome was determined with multivariate regression. The area with best outcome was defined as the safe zone and was determined with Youden\u2019s index in conjunction with receiver operating characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No significant relationship was found between tunnel aperture positions and IKDC Subjective Knee Form at 10\u2010year follow\u2010up. The posterior\u2010to\u2010anterior femoral tunnel aperture position parallel to Blumensaat line showed a significant relationship (<jats:italic>p<\/jats:italic>\u2009=\u20090.03) to overall failure at 10\u2010year follow\u2010up. The mean posterior\u2010to\u2010anterior tunnel position of the group that did not fail was 37.7% compared to 44.1% in the overall failure group. Femoral tunnel apertures placed further anteriorly had more overall failures at long\u2010term. The cut\u2010off point lies at 35.0% from posterior\u2010to\u2010anterior parallel to Blumensaat. Of the 16 overall failures, 15 (93.8%) were placed further anteriorly than the cut\u2010off point. No significant relationship was found between tunnel aperture positions and radiographic osteoarthritis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Femoral and tibial tunnel positions were not associated with long\u2010term patient\u2010reported outcome and radiographic osteoarthritis. Long\u2010term overall failure was more frequently seen in patients with a more anteriorly placed femoral tunnel. This study identified a safe zone located at the most posterior 35% of the femoral condyle parallel to Blumensaat. This knowledge offers guidance to surgeons to operate more precisely and accurately and reconstruct a long\u2010lasting graft.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>\nLevel III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-06871-1","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T12:02:56Z","timestamp":1643803376000},"page":"2003-2013","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Posteriorly positioned femoral grafts decrease long\u2010term failure in anterior cruciate ligament reconstruction, femoral and tibial graft positions did not affect long\u2010term reported outcome"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8047-8543","authenticated-orcid":false,"given":"Tim T. C. 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