A unitunnel technique for arthroscopic anterior cruciate ligament reconstruction

Anterior cruciate ligament reconstruction can now be accomplished by arthroscopic surgery. With the introduction of a new arthroscopic drill guide and accessory instrumentation, a single tibiofemoral tunnel is created through which an anterior cruciate ligament graft can be anatomically and isometrically positioned. The appropriate graft is secured intraarticularly inside the femoral portion of the tunnel. Any type of graft structure can be used with this technique by varying the diameter of the tunnel or the depth of penetration into or through the lateral femoral condyle as needed. Correct anatomic and isometric positioning of the anterior cruciate ligament graft by this method have been confirmed on cadaver studies, by direct arthroscopic visualization and testing at the time of surgery, and on postoperative radiographs. The procedure has been performed on 45 patients. The longest follow-up is 48 months; the mean follow-up is 26.3 months. Early postoperative clinical results are most encouraging, with the pivot shift test being universally negative. The unitunnel technique for arthroscopic anterior cruciate ligament reconstruction has greatly reduced surgical morbidity without apparently compromising the results of surgery. The technique could become a standard procedure for the experienced arthroscopist and knee surgeon.