How to Achieve an Accurate Anatomical Femoral Tunnel Technique in ACL Reconstruction in the Early Years of Your Consultancy? Femoral Offset Aimer Technique: Consistent and Reproducible Technique

Abstract

Femoral tunnel malposition is the most common reason for failure of primary anterior cruciate ligament reconstruction. There are several methods to identify the anatomical location of femoral footprint. Femoral offset aimer technique is one such technique which is easy to use and reliable. It is an ideal technique for junior and inexperienced surgeons to recreate the femoral tunnel in its anatomical footprint. The senior author (P.E.) has been using this technique for 30 consecutive cases in his first year of independent practice during his consultancy without any major intraoperative complications. The author describes this technique in this article with tips and tricks which will especially guide the junior and inexperienced surgeons to avoid running into intraoperative problems while drilling the femoral tunnel.

Keywords

ACL - offset aimer - anatomical femoral tunnel

Publication History

Received: 12 October 2018

Accepted: 19 May 2019

Article published online:
02 August 2019

• References

• 1 Morgan JA, Dahm D, Levy B, Stuart MJ. MARS Study Group. Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg 2012; 25 (05) 361-368
• 2 Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ. et al. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 2010; 92 (06) 1427-1431
• 3 Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH. Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 2: clinical application of surgical technique. Am J Sports Med 2011; 39 (09) 2016-2026
• 4 Bird JH, Carmont MR, Dhillon M. et al. Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis. Arthroscopy 2011; 27 (09) 1259-1267
• 5 Bernard M, Hertel P. Intraoperative and postoperative insertion control of anterior cruciate ligament-plasty. A radiologic measuring method (quadrant method) [in German]. Unfallchirurg 1996; 99 (05) 332-340
• 6 Zantop T, Ferretti M, Bell KM, Brucker PU, Gilbertson L, Fu FH. Effect of tunnel-graft length on the biomechanics of anterior cruciate ligament-reconstructed knees: intra-articular study in a goat model. Am J Sports Med 2008; 36 (11) 2158-2166
• 7 Hoshino Y, Rothrauff BB, Hensler D, Fu FH, Musahl V. Arthroscopic image distortion-part I: the effect of lens and viewing angles in a 2-dimensional in vitro model. Knee Surg Sports Traumatol Arthrosc 2016; 24 (06) 2065-2071
• 8 Gali JC, de Sousa Oliveira HC, Ciâncio BA, Palma MV, Kobayashi R, Caetano EB. Femoral tunnels' length changes with knee flexion angle in anatomical anterior cruciate ligament reconstruction. Rev Bras Ortop 2015; 47 (02) 246-250
• 9 Dave LY, Nyland J, Caborn DN. Knee flexion angle is more important than guidewire type in preventing posterior femoral cortex blowout: a cadaveric study. Arthroscopy 2012; 28 (10) 1381-1387
• 10 Nawabi DH, Tucker S, Schafer KA. et al. ACL fibres near the lateral intercondylar ridge are the most load bearing during stability examinations and isometric through passive flexion. Am J Sports Med 2016; 44 (10) 2563-2571
• 11 Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev 2017; 1 (11) 398-408
• 12 Diamantopoulos AP, Lorbach O, Paessler HH. Anterior cruciate ligament revision reconstruction: results in 107 patients. Am J Sports Med 2008; 36 (05) 851-860