Femoral tunnel position in anterior cruciate ligament reconstruction using three techniques. A cadaver study

The possibility of achieving correct deep femoral tunnel positioning during anterior cruciate ligament (ACL) reconstruction with the double incision technique (DI), the transtibial technique (TT), and the anteromedial technique (AM) was evaluated in 30 cadaver knees. A reference hole was made just deep to the insertion of the anteromedial bundle of the ACL through an anteromedial arthrotomy. In the DI technique, a Kirshner wire was inserted outside-in using a rear entry C guide. In the TT and AM techniques, the K-wire was inserted inside-out through the tibial tunnel and through the arthrotomy, respectively. The reference hole could be achieved with each technique. Using lateral radiographs, the superficial aspect of the intra-articular exit of the femoral tunnel was found to be located on average at 36%, 36%, and 34% of the width of the condyles from the posterior margin (NS). None of the holes was more anterior than 40%. In conclusion, a deep femoral tunnel positioning could be achieved with each technique. The choice of technique must be based on the surgeon's preference and clinical results.