Anatomic transtibial single-bundle anterior cruciate ligament reconstruction: a new surgical technique

Abstract

Objective Many surgeons perform anatomic anterior cruciate ligament (ACL) reconstruction through the anteromedial portal due to the difficulty in reaching the anatomic femoral insertion through the transtibial technique. A number of authors have described technical modifications to the transtibial technique to improve and restore the native femoral tunnel obliquity. In this work we present a new technique to reach the native femoral footprint in anatomic single-bundle ACL reconstruction through the transtibial tunnel with the aid of new instruments. Materials and methods From September 2009 to October 2010, 80 consecutive ACL reconstruction surgeries were performed following a prospective study design. The mean patient age was 31 years (range, 18-45 years); there were 72 male patients and eight female patients. The guide pin was inserted in the femoral footprint through the tibial tunnel with a special arthroscopic manipulator and\or pusher. Radiographic evaluation was carried out by measuring the femoral tunnel orientation in anteroposterior view in plain radiographs. Using computed tomography, the angle of femoral tunnel was measured in coronal and sagittal cuts, and the distance of the tunnel from posterior wall was measured. Clinical evaluation was performed with the IKDC scores. Results The mean angle of the femoral tunnel orientation with reference to the bicondylar line was 52.1° (range, 40°-60°). The average clock position was that of 10 O'clock. In the computed tomographic evaluation the femoral entry point at the sagittal view was 1-2 mm. The mean distance of the tunnel from the articular surface in the coronal views was 4 mm. The mean IKDC scores had increased from 55.5±18.0 to 76.8±15.3 postoperatively. Conclusion With the aid of the arthroscopic manipulator and\or the pusher, the anatomic footprint of ACL insertion site could be reached through the transtibial tunnel drilling technique.