The anatomic ACL reconstruction aims at functional restoration of the ACL to its native dimensions, collagen orientation and insertion sites. Even if the anatomic foot prints are correctly chosen for the tibial and femoral tunnels does the position of interference screw in the tibial tunnel alter the ACL orientation? The study hypothesized that the position of interference screw in the tibial tunnel would alter the graft orientation in anatomic ACL reconstruction. The purpose of this study was to compare graft orientation and inclination angle with posterolateral and anteromedial interference screw position in tibial tunnel in aperture fixation techniques.

Inclusion Criteria:

• magnetic resonance imaging (MRI) of patients with ACL reconstruction was compared to MRI in which ACL was intact.
• patients with isolated ACL injury who underwent ACL reconstruction surgery using quadripled hamstrings graft and operated by a single senior surgeon
• Both pre-operative and post-operative MRI should be available for assessment
• No history of trauma in the post-operative or rehabilitation period

Exclusion Criteria:

• Concomitant bony or other ligament injury to the same knee
• history of previous surgery to the same knee
• Revision ACL reconstruction surgery
• surgery done at other center or by other doctors at our institute
• Pre-operative and/or post-operative MRI not available