Tunnel Placement for the ACL During Reconstructive Surgery of the Knee: A Critical Analysis Review.

Abstract

Anterior cruciate ligament (ACL) surgery continues to evolve as we gain a better understanding of the anatomy and biomechanics of the ACL. In the late 1980s, there was a shift from a two-incision (rear-entry guide) to a single-incision (transtibial) technique. The impetus driving this was the potential to achieve equivalent tunnel placement more quickly and in a more cosmetic fashion1. However, when anatomic studies clearly defined the ACL femoral insertion site on the lateral intercondylar wall and not the roof, it was discovered that even when performed as described in the Surgical Techniques supplement of The Journal of Bone & Joint Surgery in 20052, the traditional transtibial technique placed the femoral tunnel higher (toward the apex of the notch as opposed to the wall) on the intercondylar notch, outside the native insertion site (Fig. 1)3-6. Some surgeons postulated that, even with adjustments to the traditional transtibial technique, transtibial drilling would always place the femoral tunnel higher on the intercondylar notch than the location of the native insertion site (Fig. 2, A ). In order to avoid placing the femoral tunnel on the intercondylar roof as is commonly associated with the transtibial technique (also known as the …