Flexible Guide Wire and Flexible Reamer for Femoral Tunnel Creation in ACL Reconstruction
DNB Orthopaedics • October 2024 • Paper IV • 10 Marks
Introduction
Successful ACL reconstruction depends on restoration of the native femoral and tibial ACL footprints. Among the technical errors causing graft failure, non-anatomic femoral tunnel placement is one of the most important.
Femoral tunnel drilling may be performed by:
- Transtibial drilling
- Independent anteromedial/transportal drilling
- Outside-in drilling
- Flexible guide-wire and flexible-reamer assisted transportal drilling
Central concept
A flexible drilling system allows the surgeon to place the femoral tunnel independently at the native ACL femoral footprint while improving the trajectory and tunnel length compared with conventional straight rigid instrumentation through the anteromedial portal.
ACL Femoral Footprint — Relevant Anatomy
The native ACL originates on the medial surface of the lateral femoral condyle within the intercondylar notch.
Important arthroscopic landmarks include:
- Lateral intercondylar ridge — resident's ridge
- Lateral bifurcate ridge when identifiable
- Posterior articular cartilage margin
- Native ACL footprint/remnant
The aim is an anatomic footprint-centered tunnel, not simply a clock-face tunnel position.
Why Was the Flexible System Developed?
Independent anteromedial portal drilling with conventional rigid instruments permits anatomic tunnel placement, but the drill approaches the lateral femoral…