title: Comparison of 4 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  The purpose of this study was to determine which femoral tunnel drilling technique most closely reproduces the anatomic femoral footprint and has acceptable tunnel length and tunnel orientation.
  
  
  METHODS
  We divided 20 cadaveric knees into 4 equal groups. Arthroscopically, the anatomic femoral footprint was marked with an awl as the tunnel starting point. In group 1 the femoral tunnel was drilled through a tibial tunnel. In groups 2 and 3 the femoral tunnel was drilled through the anteromedial arthroscopy portal, with a rigid drill and flexible drill, respectively. In group 4 the femoral tunnel was drilled with the outside-in technique over a pin positioned with an arthroscopic femoral guide. Measurements of the tunnel length, aperture, and placement were taken from 3-dimensional computed tomography scans.
  
  
  RESULTS
  Tunnel length for groups 1, 2, 3, and 4 averaged 42.08 mm, 37.73 mm, 28.92 mm, and 31.96 mm (P = .039). The mean coronal angle of the tunnels as measured from the line tangent to the posterior femoral condyles was 63.30°, 61.22°, 51.77°, and 45.00° (P = .007), and the mean distance from the inferior articular surface to the edge of the tunnel was 5.60 mm, 4.36 mm, 2.42 mm, and -0.63 mm (P = .008) for groups 1, 2, 3, and 4, respectively. There was no statistical difference in footprint length, width, area, or distance from the posterior articular margin.
  
  
  CONCLUSIONS
  Drilling by the transtibial technique produces the most vertical and longest tunnels. Independent drilling techniques produce the most anatomic tunnels but at the expense of tunnel length.
  
  
  CONCLUSIONS
  When the orthopaedic surgeon is performing ACL reconstruction, it is critical to achieve anatomic placement of the graft, as well as maintain appropriate tunnel length.
authors.affiliation: Aspen Sports Medicine Foundation, Aspen, Colorado 81611, USA. alarson@orthop.com
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Larson
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Bullock
authors.forename: Tomas
authors.initials: T
authors.lastname: Pevny
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation / Q000379:methods*; D001182:Arthroscopy; D001858:Bone Nails; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed