A new femoral drill guide for arthroscopically assisted anterior cruciate ligament replacement

There are an increasing number of drill guides and methods of selecting the most isometric femoral attachment site for reconstruction of the anterior cruciate ligament (ACL); some of these are complex and time-consuming. The senior author (R.P.) has developed a simple "inside-out" arthroscopic femoral drill guide, which is designed to reliably locate the optimal femoral attachment site. The accuracy and reliability of this guide was assessed in 10 cadaver knees. The isometry of semitendinosus tendon (ST), then patellar bone-tendon-bone (BTB) grafts was assessed in each knee. In no instance, for either reconstruction, was there greater than 3 mm graft movement through a full range of knee motion. Based on this study, we therefore conclude that this very simple drill guide is a useful tool in arthroscopic ACL reconstruction to quickly, easily, and reliably select the optimal femoral attachment site. It also negates the need for a lateral incision when using a BTB graft, thus reducing morbidity and improving cosmesis.