Comparison Between Rigid and Flexible Systems for Drilling the Femoral Tunnel Through an Anteromedial Portal in Anterior Cruciate Ligament Reconstruction

Anatomic Anterior Cruciate Ligament Reconstruction With a Flexible Reamer System and 70° Arthroscope

“…3,6 A longer femoral tunnel length is obtained by use of the flexible reamer system and 70 arthroscope while avoiding the need for knee hyperflexion and potential for surgical field contamination, logistical challenges requiring potential intraoperative assistance with positioning, anatomic distortion due to a rotated femoral condyle, and difficulty with visualization because of poor fluid egress in the notch. 7,8 Video 1 presents an example of an anatomic ACL reconstruction using flexible reamers and a 70 arthroscope.…”

Anatomical single bundle anterior cruciate ligament reconstruction

“…Care must be taken to avoid contact of the drill with the articular surface of the medial femoral condyle [76]. The use of flexible drilling systems may also improve safe tunnel position [77]. Surgeons may use two anteromedial portals: a high portal close to the patella tendon providing visualization and a second more medial portal just above the meniscus for instrumentation [78].…”

Reply to: Comments on Alentorn-Geli et al.: Anteromedial portal (AMP) versus transtibial (TT) drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

“…Although we agree that the AMP technique may produce a shorter femoral tunnel compared to the TT technique, the length of this tunnel through an accessory portal may be long enough for the bone-patellar tendon-bone graft [2,10]. Silver et al [10] found a mean distance of 37.1 mm and 43.5 mm with 120°knee flexion using straight and flexible guide pins, respectively.…”

“…Silver et al [10] found a mean distance of 37.1 mm and 43.5 mm with 120°knee flexion using straight and flexible guide pins, respectively. In our experience, a minimum length of 35 mm with a knee flexion of 110°is reached with the AMP technique, which is also consistent with Basdekis et al [2].…”

“…Using the Acufex Endoscopic femoral drill guide (Smith and Nephew®), a security distance can be systematically left in the posterior wall of the femoral condyle, thus preventing its rupture. The posterior wall blow out may be also prevented by performing the femoral drilling through an AMP as inferior and medial as possible in order to make a perpendicular drill with direct visualisation of the femoral drilling also avoiding cartilage damage of the medial femoral condyle [10].…”