Preventing Tunnel Overlap in Revision Anterior Cruciate Ligament Reconstruction Through Creation of a Single Anatomic Oval Femoral Tunnel.

Abstract

Femoral tunnel malposition is the main cause of failure in anterior cruciate ligament reconstruction. It not only contributes to the failure of initial anterior cruciate ligament reconstruction but is also of importance during the revision surgery. Tunnel positions can either be completely anatomic, completely nonanatomic, or partially anatomic. Cases with completely anatomic tunnels can make use of the same tunnel during the revision surgery, whereas cases with completely nonanatomic tunnels can make a new circular-shaped tunnel within the anatomic footprint. However, cases with partially anatomic tunnels raises concern as to where to create the new femoral tunnel within the anatomic footprint while avoiding overlap with the initial tunnel. By making the new femoral tunnel in an oval shape, we can prevent this from overlapping with the old partially anatomic tunnel while staying entirely within the anatomic footprint. The oval shape is achieved through an outside-in drilling technique using a FlipCutter and tilting the stepped drill sleeve. We present this surgical technique herein.