Digital illustration of knee joint with ACL and PLC tunnels visualized.

ACL Reconstruction: Navigating Tunnel Placement for a Successful Outcome

Rhea Morgan in Health & Wellness November 2025 • 3 min read.

"Understanding the critical factors in combined ACL and posterolateral corner reconstruction to minimize complications and optimize recovery."

Knee injuries, especially those affecting the anterior cruciate ligament (ACL) and posterolateral corner (PLC), can significantly impact an individual's mobility and quality of life. While isolated ACL or PLC injuries are challenging enough, combined injuries present a complex scenario for orthopedic surgeons.

ACL reconstruction aims to restore stability and function to the knee joint, allowing individuals to return to their active lifestyles. However, when ACL injuries are coupled with damage to the PLC, the reconstruction process becomes more intricate. One of the key challenges lies in the precise placement of tunnels for graft fixation.

This article delves into the complexities of tunnel placement during combined ACL and PLC reconstruction, drawing upon a recent study that investigated the risk of tunnel intersection. We'll explore the implications of tunnel collision, the importance of anatomical considerations, and the strategies surgeons can employ to optimize outcomes and minimize complications.

The Challenge of Tunnel Intersection

Digital illustration of knee joint with ACL and PLC tunnels visualized.

In combined ACL and PLC reconstruction, the close proximity of the tunnels created for graft placement raises the risk of tunnel intersection. This occurs when the tunnels for the ACL and PLC grafts converge or overlap within the lateral femoral condyle, potentially compromising the structural integrity of the bone and the stability of the reconstruction.

Tunnel intersection can lead to several adverse consequences:

Bone Weakening: The convergence of tunnels can weaken the bone in the lateral femoral condyle, increasing the risk of fracture or graft failure.
Graft Compromise: Tunnel intersection can impinge on the grafts, leading to reduced tension, altered biomechanics, and potential graft rupture.
Articular Cartilage Damage: Improper tunnel placement can damage the articular cartilage of the lateral femoral condyle or trochlea, contributing to pain and long-term joint degeneration.

To mitigate the risk of tunnel intersection, surgeons must carefully consider the anatomical relationships of the ACL and PLC, as well as the trajectory of the tunnels. Several techniques have been proposed to optimize tunnel placement and avoid collision, including:

Optimizing Tunnel Trajectory for Successful Reconstruction

Achieving successful outcomes in combined ACL and PLC reconstruction requires a meticulous approach to tunnel placement. By understanding the anatomical considerations, employing appropriate surgical techniques, and carefully assessing tunnel trajectory, surgeons can minimize the risk of tunnel intersection, optimize graft function, and improve the overall stability and long-term health of the knee joint. Further research and technological advancements will continue to refine these techniques and enhance the precision of tunnel placement, ultimately leading to better outcomes for patients with complex knee injuries.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3928/01477447-20130624-07, Alternate LINK

Title: Tunnel Intersection In Combined Anatomic Reconstruction Of The Acl And Posterolateral Corner

Subject: Orthopedics and Sports Medicine

Journal: Orthopedics

Publisher: SLACK, Inc.

Authors: Bennie G.P. Lindeque, Steven J. Narvy, Michael P. Hall, Ronald S. Kvitne, James E. Tibone

Published: 2013-07-01

Everything You Need To Know

What is the primary goal of ACL reconstruction, and why is it more complex when combined with PLC damage?

The primary goal of ACL reconstruction is to restore stability and function to the knee joint, allowing individuals to return to their active lifestyles. When an Anterior Cruciate Ligament (ACL) injury is coupled with damage to the Posterolateral Corner (PLC), the reconstruction process becomes more intricate due to the complex interplay of structures and the need for precise graft placement for both the ACL and PLC to ensure proper knee mechanics and long-term joint health.

What is tunnel intersection in combined ACL and PLC reconstruction, and what are the potential consequences?

Tunnel intersection occurs when the tunnels created for ACL and PLC graft placement converge or overlap within the lateral femoral condyle. This can weaken the bone, increasing the risk of fracture or graft failure. It can also impinge on the grafts, leading to reduced tension, altered biomechanics, and potential graft rupture. Furthermore, improper tunnel placement can damage the articular cartilage of the lateral femoral condyle or trochlea, contributing to pain and long-term joint degeneration.

How does tunnel trajectory impact the success of combined ACL and PLC reconstruction?

Tunnel trajectory is critical for successful outcomes. Surgeons must carefully consider the anatomical relationships of the ACL and PLC, as well as the path of the tunnels. Optimizing tunnel trajectory involves precise planning to avoid tunnel intersection, which can compromise bone integrity and graft function. Meticulous attention to tunnel placement is essential to minimize complications and improve the overall stability and long-term health of the knee joint.

What strategies do surgeons use to avoid tunnel intersection during combined ACL and PLC reconstruction?

Surgeons employ various techniques to optimize tunnel placement and avoid tunnel collision. These include a thorough understanding of anatomical considerations, the use of precise surgical techniques, and careful assessment of tunnel trajectory. By precisely planning and executing the placement of tunnels for the ACL and PLC grafts, surgeons can minimize the risk of adverse outcomes like bone weakening, graft compromise, and articular cartilage damage.

What are the long-term implications of improper tunnel placement in combined ACL and PLC reconstruction?

Improper tunnel placement in combined Anterior Cruciate Ligament (ACL) and Posterolateral Corner (PLC) reconstruction can have significant long-term implications. These include accelerated joint degeneration, increased risk of re-injury due to graft failure, and chronic pain. Correct tunnel placement is crucial for restoring normal knee biomechanics and ensuring the long-term health and function of the knee joint, allowing patients to maintain an active lifestyle and avoid premature joint deterioration.