Intraarticular placement of Kurosaka interference screws

Interference screws are commonly used for graft fixation in arthroscopically assisted anterior cruciate ligament reconstruction. A potential complication with the use of interference screws is intraarticular violation of the screw tip. Postoperative radiographs often lend confusion to the exact screw location. We devised an anatomic-radiologic study to evaluate factors (including local anatomy, radiographic projection, and radiographic technique) in order to clarify these misunderstandings. We found that radiographic projection, obliquity, and the local bony anatomy contribute to erroneous radiographic interpretation. The most significant finding was that the lateral radiograph and cephalad oblique lateral radiographs frequently suggest screw tip violation of the joint when in fact it has not occurred. Caudal oblique lateral radiographs fail to raise concern even when joint violation by the screw tip has occurred. Good quality true anteroposterior radiographs appear most consistent in determining true screw tip location.