Anterior cruciate ligament reconstruction with 70° arthroscope and flexible reamers – Early operative experience

Abstract

Anatomical graft position for anterior cruciate ligament (ACL) reconstruction is desirable. However, visualisation and positioning are challenges with the standard technique. It is known that graft integration can be improved by maximising femoral tunnel length and graft failure reduced by limiting bending angle. We planned to evaluate the use of new techniques whilst monitoring femoral tunnel length and angle.

A 70° arthroscope, through the anterolateral portal, provided improved footprint visualisation without the need to switch to a medial portal. A flexible reamer system created the femoral tunnel without hyperflexion of the knee. Femoral tunnel length was measured intra-operatively using the graduations on the reamer, and femoral tunnel angle was assessed on the post-operative radiograph (using a digital measuring tool).

In a single-surgeon, consecutive series, 55 patients were treated. When compared to the surgeon's 65 previous cases, femoral tunnel length increased significantly by 3.11 mm (40.1 (±3.49)° vs. 36.9 (±3.87)°; p < 0.05) with no significant change in femoral tunnel angle (37.8 (±4.97) mm vs. 39.6 (±5.11) mm; p = 0.075).

We discuss this technique with reference to potential advantages and disadvantages of this technology.