An Alternative Technique to Avoid Injury to the Medial Femoral Condyle When Reaming the Femoral Tunnel During Anterior Cruciate Ligament Reconstruction

Abstract

Contemporary anterior cruciate ligament reconstruction attempts to replicate the anatomical insertion sites on both the femoral and tibial sides to restore knee stability. Creation of the femoral tunnel by independently reaming through an anteromedial portal may allow surgeons to more reproducibly place the tunnel within the anatomic femoral footprint relative to a transtibial approach. However, inherent to the technique is the risk of iatrogenic injury to the articular cartilage of the medial femoral condyle as the reamers are passed adjacent to the condyle. This is particularly an issue with the use of standard nonflexible guide pins and reamers, which are placed with the knee in hyperflexion. We describe a relatively straightforward technique that can be used with standard equipment and that can be quite useful in avoiding this pitfall of the transportal approach.C ontemporary anterior cruciate ligament (ACL) reconstruction attempts to replicate the anatomic insertion sites of the ACL on both the femoral and tibial sides. On the femoral side there has been evolution and controversy in the past decade regarding the ideal technique to optimize tunnel position and restore knee stability. Investigators currently agree that anatomic single-or double-bundle tunnel placement is favored over relatively nonanatomic vertical tunnel placement, which was quite common following the adoption of transtibial femoral tunnel drilling techniques.

Iatrogenic Injury to the Posterolateral Knee During Anterior Cruciate Ligament Reconstruction with Anteromedial Portal Technique

“…This technique increases the risk of posterolateral structures injury of the knee, posterior wall, and femoral condyles damage [7], [8], [9]. Some literatures did not discuss about iatrogenic injury to the posterolateral structures in details [10], [11], [12], [13]. Hall et al performed a descriptive study on cadavers that they drilled the femoral tunnel from low-medial accessory portal to femoral cortex, with the knee flexed at 120°, 90°, and 70°.…”

Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: Challenges and Solutions of Medial Independent Femoral Tunnel Drilling

“…Previous studies have described techniques to prevent iatrogenic injury to the MFC including passing the acorn reamer and the guide pin as a composite while in knee hyperflexion or using a bio-interference screw sheath as a protective barrier for the MFC. 1,3 Here, we provide 3 techniques for femoral tunnel placement via an AM portal while preserving the MFC articular cartilage integrity. The first technique utilizes a 7-mm offset guide to estimate the position of the femoral footprint.…”