Editorial Commentary: Is It Time to Make a Change? Don't Throw Out the Old Rigid Anterior Cruciate Ligament Femoral Reamers Just Yet.

Abstract

Debate remains on which technique(s) of femoral tunnel drilling is most able to recreate an anatomic femoral footprint in anterior cruciate ligament reconstruction. The most commonly used techniques are the transtibial, anteromedial rigid reamer (AM-RR), anteromedial flexible reamer (AM-FR), and outside-in. Technique is based solely on surgeon preference. Each technique carries its own risks, benefits, advantages, and disadvantages, and there remains no single "gold standard." The AM-RR, AM-FR, and outside-in methods are considered independent or "unconstrained" methods that allow more variability in recreating anatomic angles compared with the transtibial technique, which is "constrained" by the tibial tunnel. Historically, the AM-RR and AM-FR techniques have not been subdivided in the orthopaedic literature. Further study is needed to determine whether there is a significant difference between the 2 techniques with respect to anatomical, biomechanical, and clinical results.