Skip to main content

Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique

Current Reviews in Musculoskeletal Medicine volume 4, pages 52–56 (2011)Cite this article

Abstract

The anterior cruciate ligament reconstruction is a common procedure that improves stability and function of the knee. The surgical technique continues to evolve and many issues are still under debate. These mainly include: (1) graft selection (patellar tendon, hamstring, quadriceps tendon, or allografts), (2) surgical technique (double versus single bundle), and (3) femoral tunnel drilling. Currently, the most controversial one is the femoral tunnel drilling (transtibial vs. anteromedial portal drilling). Common opinion is that drilling the femoral tunnel through the anteromedial (AM) allows a more anatomic placement of the graft and a better rotational stability; therefore, this technique is gaining in popularity compared with the transtibial drilling despite a greater difficulty and the risk of medial condyle damage, tunnel back wall blowout, and inadequate socket length. The aim of this article is to describe the surgical technique of the anterior cruciate ligament reconstruction (single and double bundle), drilling the femoral tunnel through the AM portal.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Brown CH, Carson EW. Revision anterior cruciate ligament surgery. Clin Sports Med. 1999;18:109–11.

    PubMed  Article  Google Scholar 

  2. Asano H, Muneta T, Ikeda H, et al. Arthroscopic evaluation of the articular cartilage after anterior cruciate ligament reconstruction: a short-term prospective study of 105 patients. Arthroscopy. 2004;20(5):474–81.

    PubMed  Article  Google Scholar 

  3. Gaudot F, Leymarie J-B, Drain O, Boisrenoult P, Charrois O, Beaufils P. Double-incision mini-invasive technique for BTB harvesting: its superiority in reducing anterior knee pain following ACL reconstruction. Orthop Traumatol Surg Res. 2009;95(1):28–35.

    PubMed  Article  CAS  Google Scholar 

  4. Marcacci M, Paladini Molgora A, Zaffagnini S, et al. Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy. 2003;19(5):540–6.

    PubMed  Article  Google Scholar 

  5. Harner CD, Honkamp NJ, Ranawat AS. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy. 2008;24(1):113–5.

    PubMed  Article  Google Scholar 

  6. ••Lubowitz JH, Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy. 2009 Jan;25(1):95–101. This study describes important pearls of the surgical technique.

    PubMed  Article  Google Scholar 

  7. Asagumo H, Kimura M, Kobayashi Y, et al. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy. 2007;23(6):602–9.

    PubMed  Article  Google Scholar 

  8. •Van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH. “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy. 2010 Sep;26(9 Suppl):S2-12. This study is the only systematic review that evaluate the studies published on ACL reconstruction.

    PubMed  Google Scholar 

  9. Miller CD, Gerdeman AC, Bennett CG. A biomechanical comparison of the EndoButton CL using transtibial drilling and EndoButton direct using anteromedial arthroscopic drilling. Arthroscopy. 2010;26(10):1311–7.

    PubMed  Article  Google Scholar 

  10. Fu FH, Ranawat AS. Tensioning in double-bundle ACL reconstruction. Arthroscopy. 2007;23(9):1027.

    PubMed  Article  Google Scholar 

  11. Bedi A, Musahl V, O'Loughlin P, Maak T, Citak M, Dixon P, et al. A comparison of the effect of central anatomical single-bundle anterior cruciate ligament reconstruction and double-bundle anterior cruciate ligament reconstruction on pivot-shift kinematics. Am J Sports Med. 2010;38(9):1788–94.

    PubMed  Article  Google Scholar 

  12. Markolf KL, Park S, Jackson SR, McAllister DR. Simulated pivot-shift testing with single and doublebundle anterior cruciate ligament reconstructions. J Bone Joint Surg Am. 2008;90(8):1681–9.

    PubMed  Article  Google Scholar 

  13. Bedi A, Raphael B, Maderazo A, Pavlov H, Williams 3rd RJ. Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy. 2010;26(3):342–50.

    PubMed  Article  Google Scholar 

  14. Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD. The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: a cadaveric study. Arthroscopy. 2007;23:1187–92.

    PubMed  Article  Google Scholar 

  15. Scopp JM, Jasper LE, Belkoff SM, Moorman III CT. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy. 2004;20:294–9.

    PubMed  Article  Google Scholar 

  16. Musahl V, Plakseychuk A, VanScyoc A, et al. Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament reconstructed knee. Am J Sports Med. 2005;33:712–8.

    PubMed  Article  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Affiliations

  1. Ospedale Mauriziano Umberto I Torino, SCDU Ortopedia e Traumatologia, Università degli Studi di Torino, Largo Turati 62, 10128, Torino, Italy

    Antonio Pastrone, Andrea Ferro, Matteo Bruzzone, Davide E. Bonasia, Pietro Pellegrino, Davide D’Elicio, Umberto Cottino & Roberto Rossi

Authors
  1. Antonio Pastrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Ferro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matteo Bruzzone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Davide E. Bonasia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pietro Pellegrino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Davide D’Elicio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Umberto Cottino
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Roberto Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Pastrone.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Pastrone, A., Ferro, A., Bruzzone, M. et al. Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique. Curr Rev Musculoskelet Med 4, 52–56 (2011). https://doi.org/10.1007/s12178-011-9078-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-011-9078-7

Keywords

  • Anterior cruciate ligament reconstruction
  • Antero medial portal
  • Femoral tunnel drilling
  • Surgical technique