{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T19:28:16Z","timestamp":1793042896808,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"vor","delay-in-days":175,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"vor","delay-in-days":175,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To quantify the influence of the femoral tunnel exit (FTE) on the graft bending angle (GBA) and GBA\u2010excursion throughout a full range of motion (ROM) in single\u2010bundle anterior cruciate ligament (ACL) reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Three\u2010dimensional (3D) surface models of five healthy knees were generated from a weight\u2010bearing CT obtained throughout a full ROM (0, 30, 60, 90, 120\u00b0) and femoral and tibial ACL insertions were computed. The FTE was simulated for 16 predefined positions, referenced to the Blumensaat's line, for each patient throughout a full ROM (0, 30, 60, 90, 120\u00b0) resulting in a total of 400 simulations. 3D GBA was calculated between the 3D directional vector of the ACL and the femoral tunnel, while the intra\u2010articular ACL insertions remained unchanged. For each simulation the 3D GBA, GBA\u2010excursion, tunnel length and posterior tunnel blow\u2010out were analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, mean GBA decreased with increasing knee flexion for each FTE (<jats:italic>p\u2009<\/jats:italic>&lt;\u20090.001). A more distal location of the FTE along the Blumensaat's line resulted in an increase of GBA and GBA\u2010excursion of 8.5\u2009\u00b1\u20090.6\u00b0 and 17.6\u2009\u00b1\u20091.1\u00b0 \/cm respectively (<jats:italic>p\u2009<\/jats:italic>&lt;\u20090.001), while a more anterior location resulted in a change of GBA and GBA\u2010excursion of \u20102.3\u2009\u00b1\u20090.6\u00b0 \/cm (+\u20090.6\u2009\u00b1\u20090.4\u00b0\/ cm from 0\u201360\u00b0 flexion) and 9.8\u2009\u00b1\u20091.1 \/cm respectively (<jats:italic>p\u2009<\/jats:italic>&lt;\u20090.001).<\/jats:p><jats:p>Mean tunnel length was 38.5\u2009\u00b1\u20095.2\u00a0mm (range 29.6\u201350.5). Posterior tunnel blow\u2010out did not occur for any FTE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Aiming for a more proximal and posterior FTE, with respect to Blumensaat\u2019s line, reliably reduces GBA and GBA\u2010excursion, while preserving adequate tunnel length. This might aid to reduce excessive graft stress at the femoral tunnel aperture, decrease femoral tunnel widening and promote graft\u2010healing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>IV<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40634-021-00364-9","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T18:12:57Z","timestamp":1624644777000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Influence of femoral tunnel exit on the 3D graft bending angle in anterior cruciate ligament reconstruction"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1521-2527","authenticated-orcid":false,"given":"Sandro","family":"Hodel","sequence":"first","affiliation":[{"name":"Department of Orthopedics University of Zurich Balgrist University Hospital Forchstrasse 340 8008 Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvano","family":"Mania","sequence":"additional","affiliation":[{"name":"Department of Orthopedics University of Zurich Balgrist University Hospital Forchstrasse 340 8008 Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaros","family":"Vlachopoulos","sequence":"additional","affiliation":[{"name":"Department of Orthopedics University of Zurich Balgrist University Hospital Forchstrasse 340 8008 Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"F\u00fcrnstahl","sequence":"additional","affiliation":[{"name":"Research in Orthopedic Computer Science (ROCS) University Hospital Balgrist University of Zurich Forchstrasse 340 8008 Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro F.","family":"Fucentese","sequence":"additional","affiliation":[{"name":"Department of Orthopedics University of Zurich Balgrist University Hospital Forchstrasse 340 8008 Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,25]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2015.10.006"},{"key":"e_1_2_11_3_2","first-page":"332","article-title":"Intraoperative and postoperative insertion control of anterior cruciate ligament\u2010plasty. 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