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Arthroscopically, the bone tunnel should be drilled at an angle of 40° 50° to the long axis of the tibia and should be placed anteromedially or posterior to the anterior horn of the medial meniscus and slightly anterior to the posterior cruciate ligament insertion [76, 77, 78, 79].
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The location of the bone tunnels is a crucial factor for the success of the reconstruction surgery and the bone tunnels should be placed at the original insertion site of the ruptured ACL (van Eck et al. 2010; Chechik et al. 2013).
The bony wall between both femoral bone tunnels should be a minimum of 2 mm.
It is accepted that bone tunnels should be positioned as anatomically as possible to prevent impingement, graft stretching, over constraint or restriction of motion of the knee.
If it's a hit, the tunnel should be closed for three or four years.
When considering the area of the tendon bone junction and the location of the direct insertion, the femoral tunnel should be made just posterior to the lateral intercondylar ridge during an "anatomical" reconstruction.
There was local debate whether the tunnel should be built using a tunnel boring machine or by drilling and blasting.
The directions of the two tunnels should be slightly convergent.
Two proposals suggest new bridges or tunnels should be built close to the existing crossing.
However, reliability of tunnel oxide should be carefully studied.
· With press-fit fixation a complete ossification of the femoral bone tunnel can be achieved with a minimal bony defect.
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