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This article is the author’s final published version in Journal of Arthroscopy and Joint Surgery, Volume 10, Issue 4, Oct-Dec 2023, Pages 139-148.

The published version is available at Copyright © 2023 Journal of Arthroscopy and Joint Surgery.


Purpose: The purpose of this study is to systematically review the clinical and biomechanical studies regarding noncircular (rectangular and oval) femoral tunnel anterior cruciate ligament reconstruction (ACLR). We hypothesized that noncircular femoral tunnel ACLR has its advantages in unique situations while maintaining comparable clinical and radiographic outcomes when compared to conventional techniques.

Methods: A systematic review of the literature was performed in PubMed and Scopus databases to identify published articles on the clinical outcomes of noncircular (rectangle and oval) ACLR. The results of the eligible studies were analyzed in terms of instrumented laxity measurements, Lachman test, pivot-shift test, Lysholm and Tegner scores, objective and subjective International Knee Documentation Committee (IKDC) scores, and surgical complications/failures. A meta-analysis was performed on Lysholm scores and KT side-to-side data comparing noncircular ACLR with the conventional round technique.

Results: A total of 22 papers for the rectangle group (n = 1314) met the inclusion criteria. With an average follow-up of 15.8 months (±10.4 months), the mean reported Lysholm score was 97.8 (±0.80) and the mean reported KT-1000 arthrometer measurement was 1.2 (±1.9). When comparing the rectangle technique to the conventional round, no significant differences were seen regarding the Lysholm score (P = 0.95) or KT-1000 arthrometer measurements (P = 0.14) at the final follow-up. In the oval group, a total of 5 studies (n = 322) met the eligibility criteria. With an average follow-up of 20.2 months (±13.7 months), the mean reported Lysholm score was 94.4 (±2.0), the mean IKDC subjective was 90.4 (±1.2), and the mean KT-1000 arthrometer measurement was 1.6 (±0.4). The scarcity of randomized controlled trials available for this analysis limited the amount of data available for meta-analysis. Conclusions: Noncircular femoral tunnel ACLR has shown reasonable and comparable clinical outcomes to the conventional technique, demonstrating no difference between the two techniques and making it a valuable option for primary or revision ACLR.

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Creative Commons License
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