Femoral interference screw placement through the tibial tunnel: a novel method without graft damage

A frequently encountered problem in endoscopic 1-incision anterior cruciate ligament (ACL) reconstruction is the difficulty involved in accurately inserting the femoral interference screw without significant and undesirable divergence between the screw and the graft when a femoral interference screw is fixed through the anteromedial portal. To minimize divergence, the authors demonstrated a modified, easy, and reproducible procedure that can be performed without causing graft injury or requiring special instrumentation. A ligament reconstruction route is created with the use of an ACL guide system. Lead graft sutures are pulled through the anteromedial portal by way of the femoral tunnel and out the anterolateral thigh first. The tendon graft is then inserted through the anteromedial portal and up into the femoral tunnel. A guidewire is introduced through the tibial tunnel into the femoral tunnel. An appropriately sized BioScrew (Linvatec, Largo, FL) is inserted, with the use of a guidewire inside the screw, through the tibial tunnel into the femoral tunnel. The graft is then retrieved through the anteromedial portal and is inserted through the tibial tunnel. Finally, the tendon graft in the tibial tunnel is similarly fixed with a BioScrew of the same size. Moreover, this novel approach is feasible for all tendon grafts (bone-patellar tendon-bone grafts, quadriceps tendon-patellar bone grafts, and hamstring tendon grafts).