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This is because tibial tunnel-independent techniques tend to make the femoral tunnel apertures less elongated than the transtibial technique, and there is a lower risk of overlap with the two tunnels when double-bundle reconstruction is performed.20,33 Alternatively, surgeons should select the anatomical single-bundle reconstruction from the beginning in those cases with short stature. A previous study has also reported that a narrow notch (Selleckchem OTX015 more discussion.35,36 Limitations One of the limitations associated with this study was that the geographic data on the ACL femoral tunnel positions were not directly obtained from in vivo knees or cadaveric specimens, but from indirect CAD data superimposed based on the ratio obtained from an anatomical study.22,23 The direct observation of cadavers would be more desirable to assess basic anatomical information, but ethical restrictions and low availability made it difficult to use a sufficient number of cadavers for such fundamental research. However, the key point of this study was not to survey footprint anatomy, but to simulate and ALPI evaluate the relationship of the two tunnel apertures when anatomical double-bundle ACL reconstruction is performed. In addition, Selleckchem Rucaparib the positional data based on high resolution 3-D CT data are considered to be as accurate as in vivo knees and cadaveric specimens. Because the quadrant method has been widely used for the postoperative evaluation of tunnel position after ACL reconstruction in recent years,20,23,37,38 it stands to reason that we used this method for simulating the AM and PL tunnel center. Conclusion In the 3-D CAD simulation of double-bundle ACL reconstruction with the location of the femoral tunnels accurately positioned anatomically, the distance between the AM and PL centers was 10.2��0.6 mm in males and 9.4��0.5 mm in females (P