Ensuring accurate femoral guide pin placement in anterior cruciate ligament reconstruction

The correct placement of the femoral tunnel is of critical importance in successfully reconstructing a knee with a deficient anterior cruciate ligament. By inserting the femoral guide pin through the anteromedial portal with the knee fully flexed, and subsequently withdrawing the pin from the anterior thigh until just the end of the pin remains at the insertion site at the posterior aspect of the intercondylar notch, the knee can then be safely extended and a thorough arthroscopic evaluation performed. In addition, the arthroscope can now be introduced into the medial portal to better evaluate the pin placement. Thus, visualization of the pin position and accurate placement based upon the intended tunnel size can be confirmed prior to drilling of the femoral tunnel, and more reproducibility in anterior cruciate ligament reconstructions can be achieved.