Anatomic femoral tunnel creation during anterior cruciate ligament reconstruction using curved dilator system

Abstract

Purpose: Recently, tunnel placements in anatomic positions have been emphasized for successful restoration of knee function after anterior cruciate ligament (ACL) reconstruction. The anteromedial portal technique is considered to be more favorable than the transtibial technique for anatomic femoral tunnel placements; however, it has some technical disadvantages. To minimize these disadvantages, the authors developed the curved dilator system (CDS). The purpose of this study was to evaluate the femoral tunnel position, length, and intraoperative complications with CDS. Methods: Sixty-two consecutive patients who underwent ACL reconstruction with CDS were subjects of this study. The femoral tunnel was created using a 4.5 mm-diameter curved guide trocar and was widened in a step-by-step manner, increasing by 1 mm dilator diameter to match the graft with the knee flexed to slightly over 90°. Femoral tunnel positions were evaluated by the quadrant method from postoperative computed tomographic images. Femoral tunnel length was measured using the curved depth gauge during surgery. Complications such as posterior wall blowout and cartilage damage were checked intraoperatively. Peroneal nerve injury was observed during the hospital stay. Results: Femoral tunnel position was 32.7% ± 5.4% and 39.1% ± 5.9% in the superior-inferior and anterior-posterior positions, respectively. Femoral tunnel length was 39.2 ± 4.1 mm. Damage to medial femoral condyle cartilage, posterior wall blowout, and peroneal nerve injury did not occur in any case. Conclusion: ACL reconstruction with CDS resulted in anatomic positioning of the femoral tunnel and sufficient femoral tunnel length without intraoperative complications.