Avoiding Femoral Tunnel Convergence and Graft Damage While Performing Anterior Cruciate Ligament Reconstruction With...

Lateral extra-articular tenodesis (LET) procedures have become increasingly popular in recent years as adjuncts to anterior cruciate ligament (ACL) reconstruction. One potential complication of combining LET with ACL reconstruction is tunnel convergence, which can lead to inadvertent loss of femoral ACL graft fixation. While modern LET techniques have incorporated suture anchors to avoid tunnel convergence, there is still a significant risk of anchor-tunnel convergence leading to loss of ACL graft fixation, especially when utilizing suspensory fixation devices and anteromedial portal femoral drilling. Previous techniques have described drill angulation and high knee flexion angles during LET tunnel/anchor placement to avoid this complication but are highly dependent upon user experience or may require additional operating room assistants for leg positioning. We describe our surgical technique to avoid damaging ACL graft suspensory fixation devices when performing ACL reconstruction with a concurrent modified Lemaire LET.