Tunnel combinations that should be avoided in anterior cruciate ligament reconstruction

In conclusion, tunnel combinations with the steepest (sagittal plane) and/or least oblique (frontal plane) grafts resulted in increased anterior tibial translation and tibial rotation, and should therefore be avoided. Anterior positioning of the graft caused extension deficiency, and there was flexion deficit with most grafts. A femoral tunnel as far posterior as possible by anteromedial technique is preferable in combination with an anatomically positioned tibial tunnel.