Reliable Anatomic Femoral Tunnel Positioning for Anterior Cruciate Ligament Reconstruction Using a Novel Femoral Aiming Guide

Abstract

Background: Anterior cruciate ligament (ACL) tunnel placement has been long debated for many years. Femoral tunnel mal-position is the commonest technical error resulting in early ACL laxity and failure. There are many different methods to achieve accurate femoral tunnel position. In this video, we describe use of a novel femoral jig aiming device to drill a reliably and easily reproducible femoral tunnel for primary ACL reconstruction (ACLR). Indications: This femoral jig aiming device is indicated for all patients undergoing primary ACLR with any graft chosen by the surgeon. This jig is particularly useful for the inexperienced and low volume ACLR surgeon. Technique Description: An appropriate graft is harvested and prepared according to preferred techniques and the diameter of the graft to be inserted in the femoral tunnel is measured. The femoral notch is prepared, ensuring appropriate tissue is cleared to view the apex of the deep cartilage (ADC). The Infinity anteromedial (AM) femoral guide (Conmed), is inserted through the AM portal and hooked onto the notch just proximal to the ADC. In deep flexion, the guide wire is advanced and the tunnel reamed, aiming to preserve 2.0 to 2.5 mm of bone. Results: 19 consecutive patients were operated on. There were no complications during the intra- and postoperative period. There have been no reported failures or graft ruptures. All tunnels (100%) were centered in the footprint. The mean tunnel position was 25:20 on the superimposed Bernard-Hertel grid with tight grouping. Discussion/Conclusion: We have shown that this new femoral guide accurately locates the femoral tunnel close to the AM bundle position and gives a reliable and reproducible femoral tunnel position, thereby reducing the risk of intra-operative error. This may assist accuracy of tunnel position for surgeons starting out performing ACLR or for low-volume surgeons. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.