A Femoral Tunnel View Test During ACL Reconstruction

Abstract

Despite technologic advances in the surgical techniques for anterior cruciate ligament (ACL) reconstruction, some patients continue to have violation of the femoral cortex, commonly referred to as wall blowout. These posterior or lateral cortical breaches lead to loss of graft containment and subsequent difficulty with graft fixation. If this intraoperative error is not promptly recognized and treated, the graft is at an increased risk of premature failure. Thus, in these situations, recognizing the complication and knowing strategies for alternative or salvage fixation are of importance. This article details a simple tunnel view test realized during ACL reconstruction that would enable determining the integrity and depth of the femoral tunnel. The femoral tunnel view test is a technically straightforward and quick test able to obtain a superior view of patient anatomy to facilitate accurate tunnel integrity evaluation during ACL reconstruction.

The femoral tunnel view test during ACL reconstruction can ensure tunnel integrity

“…The 584 (91.3%) patients included in the final study group underwent ACLR using the inside-out technique described below (quadruple hamstring technique) 15 , 16 ; the procedures were performed by the Knee Group of this institution.…”

“…The technique used is a previously published modification, which is briefly described herein. 8 , 14 , 15 , 17 The grafts are removed with an open stripper, preserving the tibial insertion, which ensures better fixation and vascularization. The knee should be flexed at 120° for better visualization when the femoral tunnel is punctured.…”

“…1 ). 15 In case of a small fracture of the posterior wall, tunnel length must be increased. The tibial tunnel is drilled in a standard manner, with a guide near the medial tibial spine and anteriorly to the tibial insertion of the posterior bundle of the ACL.…”

Tunnel Management in Revision Anterior Cruciate Ligament Reconstruction: Current Concepts

“…A formal femoral tunnel view test in which the arthroscope is introduced through the anteromedial portal and advanced into the femoral tunnel for direct, 360° visualization of the tunnel walls has been described. 72…”

The Tibial Tug Test: An Intraoperative Test to Assess Tibial Fixation During Anterior Cruciate Ligament Reconstruction

“… 4 The most common cause of failure is the improper placement of the tunnels, which can be found in 70% to 80% of failed ACL reconstructions according to Temponi et al. 5 Anatomic tunnel placement is necessary to avoid rerupture of the graft.…”