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The effect of femoral guide rotation in endoscopic anterior cruciate ligament (ACL) reconstruction is reviewed based on a previous report. The effect of varied offsets of the femoral guide (5.5 and 7.0 mm) are described. This is one of the few isometry studies to evaluate the knee through a practically full range of motion (0 degree-120 degrees). A 7-mm offset guide rotated to the 12:00 position yields the best single fiber and graft excursion patterns (P < 0.05). A 5.5-mm offset guide yields inferior single fiber and graft excursion patterns. Single fiber and graft isometry are similar but not identical in endoscopic ACL reconstruction. Centering the single fiber in the tibial tunnel has little effect on isometry patterns, demonstrating that the more posterior tibial positions needed for endoscopic reconstruction are acceptable from an isometry standpoint.

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