Predictive Factors for Hamstring Autograft Diameter in Anterior Cruciate Ligament Reconstruction

2019 ◽  
Author(s):  
Willem M.P. Heijboer ◽  
Mathijs A.M. Suijkerbuijk ◽  
Belle L. van Meer ◽  
Eric W.P. Bakker ◽  
Duncan E. Meuffels
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Model ◽  
Gracilis Tendon ◽  
Thigh Circumference ◽  
Anterior Cruciate

AbstractMultiple studies found hamstring tendon (HT) autograft diameter to be a risk factor for anterior cruciate ligament (ACL) reconstruction failure. This study aimed to determine which preoperative measurements are associated with HT autograft diameter in ACL reconstruction by directly comparing patient characteristics and cross-sectional area (CSA) measurement of the semitendinosus and gracilis tendon on magnetic resonance imaging (MRI). Fifty-three patients with a primary ACL reconstruction with a four-stranded HT autograft were included in this study. Preoperatively we recorded length, weight, thigh circumference, gender, age, preinjury Tegner activity score, and CSA of the semitendinosus and gracilis tendon on MRI. Total CSA on MRI, weight, height, gender, and thigh circumference were all significantly correlated with HT autograft diameter (p < 0.05). A multiple linear regression model with CSA measurement of the HTs on MRI, weight, and height showed the most explained variance of HT autograft diameter (adjusted R 2 = 44%). A regression equation was derived for an estimation of the expected intraoperative HT autograft diameter: 1.2508 + 0.0400 × total CSA (mm2) + 0.0100 × weight (kg) + 0.0296 × length (cm). The Bland and Altman analysis indicated a 95% limit of agreement of ± 1.14 mm and an error correlation of r = 0.47. Smaller CSA of the semitendinosus and gracilis tendon on MRI, shorter stature, lower weight, smaller thigh circumference, and female gender are associated with a smaller four-stranded HT autograft diameter in ACL reconstruction. Multiple linear regression analysis indicated that the combination of MRI CSA measurement, weight, and height is the strongest predictor.

scholarly journals Effect of Patient Height and Sex on the Patellar Tendon and Anterior Cruciate Ligament

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110032
Author(s):  
Abigail L. Campbell ◽  
Jon-Michael E. Caldwell ◽  
Dheeraj Yalamanchili ◽  
Lia Sepanek ◽  
Keon Youssefzadeh ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Regression Analysis ◽  
Linear Regression ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Linear Regression Analysis ◽  
Female Patients ◽  
Male Patients ◽  
Anterior Cruciate

Background: Graft-tunnel mismatch is an avoidable complication in anterior cruciate ligament (ACL) reconstruction. Patient height and sex may be predictors of patellar tendon length (PTL) and intra-articular ACL length (IAL). Understanding these relationships may assist in reducing graft-tunnel mismatch during ACL reconstruction with bone–patellar tendon–bone (BTB) autograft. Purpose: To determine the association of patient height and sex with PTL and IAL. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance imaging (MRI) studies were obtained on the healthy knees of 100 male and 100 female patients. Patients with prior surgery, open physes, significant degenerative changes, ACL rupture, or extensor mechanism injury were excluded. Three independent readers measured PTL, IAL, and Caton-Deschamps Index (CDI) on MRI. Bivariate and linear regression analysis was performed to detect the association of anthropometric data with anatomic parameters measured on MRI studies. Results: The mean age and body mass index were not significantly different between the male and female patients; however, male patients were significantly taller than female patients (1.75 vs 1.72 m, respectively; P < .001). There was a substantial agreement between the 3 readers for all parameters (κ > 0.75). Overall, female patients had significantly longer PTL (47.38 vs 43.92 mm), higher CDI (1.146 vs 1.071), and shorter IAL (33.05 vs 34.39 mm) ( P < .001 for all). Results of the linear regression analysis demonstrated that both height and female sex were predictive of longer PTL. Further, height was independently predictive of IAL but sex was not. Conclusion: PTL was correlated more with patient sex than height. IAL was also correlated with patient sex. Longer BTB grafts are expected to be harvested in female patients compared with male patients of the same height despite shorter IAL. These associations should be considered during BTB ACL reconstruction to minimize graft-tunnel mismatch.

EVALUATION OF RESULT OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH USE OF SEMITENDINOUS AND GRACILIS TENDON AT HUE UNIVERSITY HOSPITAL

2016 ◽  
pp. 41-47
Author(s):  
Van Thanh Nguyen ◽  
Nghi Thanh Nhan Le
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
University Hospital ◽  
Knee Stability ◽  
Gracilis Tendon ◽  
Lachman Test ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) rupturecauses knee instability and secondary injuries at meniscus, cartilage and the other ligaments. Therefore, ACL reconstruction is necessary. The aim of the study is to evaluate the results of ACL reconstruction with autogenous semitendinous and gracilis tendons at the Hue University Hospital. Methods: A prospective study of 40 patients with ACL ruptures treated with arthroscopically assisted reconstruction with autogenous semitendinous and gracilis tendons. Knee stability and functional Lysholm scores were recorded at each visit, including preoperatively and at the third and sixth month of follow-up. Results: Forty patients (male : female = 1,6) with a mean age of thirty years) were involved in the study. The main cause of ACL rupture is trafic accident (62,5%). All of patients had positive Lachman test and thirdty two (80%) of the patients had positive drawtest. Mean knee functional Lysholm score was 56 points. Follow-up to six months, resulting in a final study of thirty one patients, Lachman test was negative in 93,6%. The mean Lysholm scores improved to 83 points at third month and 89 points at sixth month. Conclusions: We believe that, semitendinous and gracilis tendon graft was effective and safety technique for recovery of knee stability and function.

scholarly journals Anthropometric data and the cross-sectional area (CSA) of the semitendinosus and gracilis tendons measured with preoperative MRI to predict graft diameter for anterior cruciate ligament reconstruction

2021 ◽  
Vol 27 (2) ◽  
pp. 237-242
Author(s):  
M.S. Ryazantsev ◽  
◽  
N.E. Magnitskaya ◽  
A.R. Zaripov ◽  
A.N. Logvinov ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Linear Regression ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Anthropometric Data ◽  
Cross Sectional ◽  
Anterior Cruciate ◽  
Graft Diameter

Introduction Anterior cruciate ligament (ACL) reconstruction with quadrupled hamstring tendon autograft is a safe and reproducible surgery with good functional outcomes. Currently there is no consensus on capability of graft diameter planning. Objectives To investigate the influence of anthropometric data and cross-sectional area of semitendinosus (ST) and gracilis (GR) tendons according to preoperative magnetic resonance imaging (MRI) on intraoperative graft diameter. Material and methods The study included 111 consecutive patients (69 men and 42 women), who underwent ACL reconstruction with quadrupled hamstring autograft between 2015 to 2018. Height, weight and BMI were recorded in all patients preoperatively. Semitendinosus and gracilis tendons cross sectional areas (CSAst and CSAgr, respectively) were evaluated on preoperative MRI axial images. We also calculated doubled and quadrupled graft diameters (CSAst+gr and CSA4p, respectively) based on obtained MRI data. Collection of intraoperative data included length of each tendon separately, length and diameter of the resulting autograft. We used linear regression and Pearson correlation coefficient were used. The crosssectional areas were correlated to antropometric and intraoperative data. Using logistic regression, we determined the probability of obtaining a graft diameter of ≥ 7.5 mm. A critical level of statistical significance was set as 5 % (p ≤ 0.05). Results The median age accounted 37.4 ± 0.89 (13–58) years, height – 174.6 ± 0.84 (156–200) cm, weight – 78.5 ± 1.52 (45–120) kg, BMI – 25.6 ± 0.37 ( 18.49–41.5). Intraoperatively GR average length was 224.7 ± 3.06 (80–340) mm, ST – 256.3 ± 2.97 (160–340) mm, quadrupled graft – 111.3 ± 1.42 (80–140) mm. The most common graft diameter was 7 mm in females and 7.5 mm in males. We found strong positive correlation between graft diameter and CSA4p, СSAst+gr, CSAst, weight and height. Linear regression showed that graft diameter was influenced by CSA4p, СSAst+gr, CSAst and height. If CSA4p was ≥ 72 mm2, the probability of obtaining a graft of ≥ 7.5 mm at the time of surgery reached 90.6 %. Conclusion CSA4p may be used as a predictive characteristic for graft diameter preoperative planning. Our findings show that graft diameter was mainly influenced by height, СSAst+gr, CSAst and CSA4p.

scholarly journals Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098164
Author(s):  
Steven F. DeFroda ◽  
Devan D. Patel ◽  
John Milner ◽  
Daniel S. Yang ◽  
Brett D. Owens
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Case Series ◽  
National Basketball Association ◽  
High Rate ◽  
Return To Play ◽  
Lower Percentage ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR). Purpose/Hypothesis: To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2. Study Design: Case series; Level of evidence, 4. Methods: An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints. Results: A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season ( P = .0056). Performance in the second postoperative season was not significantly different versus preinjury. Conclusion: NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.

scholarly journals EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Brett Heldt ◽  
Elsayed Attia ◽  
Raymond Guo ◽  
Indranil Kushare ◽  
Theodore Shybut
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Skeletal Maturity ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscus Tears ◽  
Anterior Cruciate

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.

There is an Association of Synovial Interleukin-6 Levels With Chondral Damage in Anterior Cruciate Ligament–Deficient Knees

2021 ◽  
pp. 155633162199200
Author(s):  
Ravi Gupta ◽  
Anil Kapoor ◽  
Sourabh Khatri ◽  
Dinesh Sandal ◽  
Gladson David Masih
Keyword(s):  
Anterior Cruciate Ligament ◽  
Synovial Fluid ◽  
Acl Reconstruction ◽  
Inflammatory Cytokines ◽  
Interleukin 6 ◽  
Cruciate Ligament ◽  
Interleukin 1 ◽  
Chondral Damage ◽  
Anterior Cruciate ◽  
Acl Deficient

Background: Osteoarthritis (OA) in the anterior cruciate ligament (ACL)–deficient knee is seen in approximately 50% of affected patients. Possible causes include biochemical or biomechanical changes. Purpose: We sought to study the correlation between inflammatory cytokines and chondral damage in ACL-deficient knees. Methods: Seventy-six male patients who underwent ACL reconstruction were enrolled in a cross-sectional study. Synovial fluid was aspirated before surgery and analyzed for levels of the inflammatory cytokines tumor necrosis factor-α, interleukin-1 (IL-1), and interleukin-6 (IL-6). At the time of ACL reconstruction, the severity of chondral damage was documented as described by the Outerbridge classification. Results: Patients with grade 2 or higher chondral damage were observed to have elevated IL-6 levels when compared to patients who had no chondral damage. Interleukin-6 levels had no correlation with the duration of injury. Conclusion: Elevated levels of IL-6 in synovial fluid were associated with chondral damage in ACL-deficient knees. Further study is warranted to determine whether inflammatory cytokines contribute to the development of OA of the knee after ACL injury.

scholarly journals Comparison of Blood Flow Restriction Training versus Non-Occlusive Training in Patients with Anterior Cruciate Ligament Reconstruction or Knee Osteoarthritis: A Systematic Review

2020 ◽  
Vol 10 (1) ◽  
pp. 68
Author(s):  
Cristina Bobes Álvarez ◽  
Paloma Issa-Khozouz Santamaría ◽  
Rubén Fernández-Matías ◽  
Daniel Pecos-Martín ◽  
Alexander Achalandabaso-Ochoa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Blood Flow ◽  
Anterior Cruciate Ligament ◽  
Knee Osteoarthritis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Flow Restriction ◽  
Anterior Cruciate

Patients undergoing anterior cruciate ligament (ACL) reconstruction and patients suffering from knee osteoarthritis (KOA) have been shown to have quadriceps muscle weakness and/or atrophy in common. The physiological mechanisms of blood flow restriction (BFR) training could facilitate muscle hypertrophy. The purpose of this systematic review is to investigate the effects of BFR training on quadriceps cross-sectional area (CSA), pain perception, function and quality of life on these patients compared to a non-BFR training. A literature research was performed using Web of Science, PEDro, Scopus, MEDLINE, Dialnet, CINAHL and The Cochrane Library databases. The main inclusion criteria were that papers were English or Spanish language reports of randomized controlled trials involving patients with ACL reconstruction or suffering from KOA. The initial research identified 159 publications from all databases; 10 articles were finally included. The search was conducted from April to June 2020. Four of these studies found a significant improvement in strength. A significant increase in CSA was found in two studies. Pain significantly improved in four studies and only one study showed a significant improvement in functionality/quality of life. Low-load training with BFR may be an effective option treatment for increasing quadriceps strength and CSA, but more research is needed.

scholarly journals Is Edema at the Posterior Medial Tibial Plateau Indicative of Ramp Lesion? An Examination of 852 Patients with Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013
Author(s):  
Neil Kumar ◽  
Tiahna Spencer ◽  
Edward Hochman ◽  
Mark P. Cote ◽  
Robert A. Arciero ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Mechanism Of Injury ◽  
Medial Tibial Plateau ◽  
Meniscal Tears ◽  
Ramp Lesion ◽  
Anterior Cruciate ◽  
Operative Notes

Objectives: Meniscal injuries are commonly observed with anterior cruciate ligament (ACL) deficiency. A subset of these injuries includes tears of the medial meniscus at the posterior meniscocapsular junction, or ramp lesions. Biomechanical studies have indicated that ramp injuries may compromise anterior stability of the knee, even after ACL reconstruction (ACLR). These lesions are not consistently diagnosed with magnetic resonance imaging (MRI). One criterion that shows promise is the presence of posterior medial tibial plateau (PMTP) edema. A correlation of PMTP edema and peripheral posterior horn medial meniscal injuries has been observed in the literature. We evaluated a consecutive series of patients who underwent ACLR for incidence of ramp tears. These patients were then compared to patients with non-ramp (meniscal body) medial meniscal tears. The utility of PMTP edema on preoperative MRI for ramp tear diagnosis was then determined. Methods: A retrospective chart review via an institutional database search identified 892 patients who underwent ACLR by one of two senior authors (R.A.A., C.E.) between January 2006 and June 2016. Operative notes identified patients diagnosed arthroscopically with medial meniscal lesions, including ramp lesions. Arthroscopic identification was the gold standard for diagnosis of both ramp and non-ramp (meniscal body) tears. Demographic information such as age, sex, laterality, mechanism of injury (contact/noncontact), sport, revision procedure, multi-ligament procedure, time to MRI, and time to surgery were recorded. Patients without available operative records were excluded. Preoperative MRIs were obtained for all patients and reviewed by an orthopaedic sports medicine fellow for PMTP edema. Axial, coronal, and sagittal T2 and proton-density sequences were utilized. A MRI was considered positive if edema was detected in 2 different planes of sequences. Differences between groups were analyzed with two-sample t test or Chi square test Univariate and multivariate logistic regression models analyzed the relationships among patient factors, MRI findings, and ramp lesions. Results: 852 patients met the inclusion criteria for analysis. 307 patients were diagnosed with medial meniscal tear at the time of ACLR, 127 of which were ramp lesions. The overall incidence of ramp tear was 14.9% and consisted of 41.4% of all medial meniscal tears. Patients with ramp tears were mean 7.5 years younger than patients with meniscal body tears ( p<0.01). There was no difference between the groups in regard to mechanism of injury, revision surgery, or multi-ligamentous injury. Patients with delayed ACLR were at 3.3x greater odds ( p<0.01) of having meniscal body tear compared to ramp lesion. MRI was available for review in 178 patients, 97 of whom had positive MRI for PMTP edema. Sensitivity and specificity of PMTP edema for ramp tear was 66.3% and 55.1%, respectively. Of patients with PMTP edema, 54.6% had ramp lesions and 45.4% had non-ramp tears ( p<0.01). Patients with preoperative MRI positive for PMTP edema were at 2.1 times greater odds ( p<0.01) of having sustained a ramp tear compared to a meniscal body tear. Conclusion: The incidence of ramp tear was 14.9% and was more prevalent in younger patients. Delayed ACLR resulted in 3.3x greater odds of meniscal body tears compared to ramp tears. Patients with PMTP edema on preoperative MRI were at 2.1x greater odds to have ramp lesions compared to a meniscal body tears at the time of ACL reconstruction.

Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction

2013 ◽  
Vol 21 (9) ◽  
pp. 2072-2080 ◽  
Author(s):  
Marcus Hofbauer ◽  
Bart Muller ◽  
Christopher D. Murawski ◽  
Michael Baraga ◽  
Carola Franziska van Eck ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Anterior Cruciate

scholarly journals Correlation of Femoral Tunnel Length with Body Height, Limb Length, and Thigh Length in Indian Patients Undergoing Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 24 (3) ◽  
pp. 286-288
Author(s):  
Ravi Gupta ◽  
Anubhav Malhotra ◽  
Pawan Kumar ◽  
Gladson David Masih
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Body Height ◽  
Limb Length ◽  
Tunnel Length ◽  
Indian Patients ◽  
Anterior Cruciate ◽  
Hamstrings Tendon

Purpose To measure the femoral tunnel length created through a far medial portal and determine its correlation with body height, limb length, and thigh length in 404 Indian patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods 364 male and 40 female Indian patients aged 18 to 51 (mean, 26.8) years underwent ACL reconstruction by a single surgeon using the hamstrings tendon autograft. Their body height, limb length, and thigh length were measured by a single assessor, as was the femoral tunnel length. Results The mean femoral tunnel length was 34.5 mm. It was <30 mm in 28 patients and <25 mm in 2 patients. The correlation coefficients of the femoral tunnel length with body height, limb length, and thigh length were 0.485 (p<0.0001), 0.426 (p<0.0001), and 0.304 (p<0.0001). No patient had posterior wall blowout fracture. Conclusion The femoral tunnel length positively correlated with body height, limb length, and thigh length in 404 Indian patients.

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