Drill wobble - effect on femoral tunnel aperture during anterior cruciate ligament reconstruction

In anterior cruciate ligament reconstruction performed using cortical button fixation on the femur, we have observed a "wobble" effect that can occur when a cannulated femoral drill is used over a guide pin that is not securely fixed in bone. Our study assessed the effect of drill "wobble" on femoral tunnel aperture in sawbones.

Femoral tunnels were drilled in sawbones, which had been divided in two groups of 10 each, per drilling technique. The "wobble" technique group had the smaller cortical button drill passed before drilling the graft socket with the bigger diameter femoral drill. In contrast, in the "non-wobble" technique group, the smaller cortical button drill was passed after drilling the graft socket. The aperture dimensions: antero-posterior, proximo-distal and oblique, as well as the length of each tunnel, were measured.

While the average dimensions of the tunnels were similar between the two techniques, there was significantly more variation in the antero-posterior measurements for the wobble technique as compared to the non-wobble technique (mean 7.3 mm, SD 0.28 mm, and mean 7.3 mm, SD 0.11 mm, respectively; Brown-Forsythe test, p 0.02).

We conclude that using the "socket first" "non-wobble" technique is a single surgical technical step surgeons can employ to decrease variability in tunnel aperture and size.