title: Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  Femoral tunnel location is of critical importance for successful outcome of ACL reconstruction. The aim was to study the femoral tunnel created by placing free hand guide wire through tibial tunnel, using the toggle of the guide wire in the tibial tunnel to improve femoral tunnel location.
  
  
  METHODS
  30 cases of a single bundle quadrupled hamstring graft anterior cruciate ligament reconstruction by trans-tibial free hand femoral tunnel creation is studied in this prospective study. The side to side play of the guide wire in the tibial tunnel was used to improve the tunnel location on femoral wall. The coronal angle of the femoral tunnel was measured on the anteroposterior radiograph. The femoral tunnel location on the lateral radiograph of the knee was recorded according to Amis method. Lysholm scoring was done preoperative and at each follow up. Assessment of laxity was done by Rolimeter (Aircast(™)) and pivot shift test.
  
  
  RESULTS
  The mean coronal angle of the femoral tunnel in postoperative radiograph was 47°. In lateral radiograph, the femoral tunnel was found to be >60% posterior on Blumensaat line in 67% cases (n = 20) and in the 33% cases (n = 10) it was anterior. The mean Lysholm score improved from 74.6 preoperative to 93.17 postoperative with no objective evidence of laxity.
  
  
  CONCLUSIONS
  The free hand trans-tibial creation of the femoral tunnel leads to satisfactory coronal obliquity, but it is difficult to recreate anatomic femoral tunnel by this method as the tunnel is consistently anterior in the sagittal plane.
authors.affiliation: Department of Orthopaedics, Dr. RML Hospital, PGIMER, New Delhi, India.
authors.forename: Skand
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Orthopaedics, Dr. RML Hospital, PGIMER, New Delhi, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Naik
authors.affiliation: Department of Orthopaedics, Dr. RML Hospital, PGIMER, New Delhi, India.
authors.forename: C S
authors.initials: CS
authors.lastname: Arya
authors.affiliation: Department of Orthopaedics, Dr. RML Hospital, PGIMER, New Delhi, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Arya
authors.affiliation: Department of Orthopaedics, Dr. RML Hospital, PGIMER, New Delhi, India.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Jain
authors.affiliation: Department of Orthopaedics, Dr. RML Hospital, PGIMER, New Delhi, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Upadhyay
keywords: ACL reconstruction; Femoral tunnel; Knee; anterior cruciate ligament; anterior cruciate ligament reconstruction; arthroscopy; single bundle; trans-tibial