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, 3 (1), e175-9
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Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

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Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Jin Hwan Ahn et al. Arthrosc Tech.

Abstract

We established a method for creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament (ACL) reconstruction. The goals of this surgical technique were to preserve the remnant bundle as much as possible, especially at the femoral insertion, and to make the tunnel at the anatomic position. The critical points are that the posterior side of the femoral footprint of the ACL is observed through the posterolateral portal using a 70° arthroscope and a femoral tunnel is made by use of an outside-in technique with remnant preservation. This technique allows for easy viewing of the posterior side of the ACL and enables performance of an anatomic ACL reconstruction.

Figures

Fig 1
Fig 1
For remnant preservation, 3 sutures are placed near the proximal end of the remnant ACL and the free end of the suture in the intercondylar notch is grasped and brought up to the AM portal.
Fig 2
Fig 2
In a right (Rt) knee, through a PL portal, the 70° arthroscope is inserted and advanced to reach the posterior aspect of the intercondylar notch. The posterior margin of the ACL footprint can be observed.
Fig 3
Fig 3
Gross appearance during formation of anatomic femoral tunnel in right (Rt) knee. The arthroscope is inserted through the PL portal, and the ACL tibial drilling guide (Linvatec) is introduced through the AL portal.
Fig 4
Fig 4
Postoperative 3-dimensional computed tomography image. The center point of the AM tunnel usually shows good correspondence with the anterior-proximal end of the cartilage margin.
Fig 5
Fig 5
(A) In the right (Rt) knee, viewing through the AL portal, the reconstructed graft is wrapped with a preserved remnant. (B) Viewing through the PL portal, the reconstructed graft is passed at the posterior margin of the cartilage with remnant preservation.

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