title: Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator.
abstract: BACKGROUND
  This study aimed to present a new technique for anatomical single bundle anterior cruciate ligament (ACL) reconstruction. We developed an original rounded rectangular dilator set to create rounded rectangular femoral tunnels. This technique can increase the femoral tunnel size without roof impingement, and has the potential to reduce the graft failure rate. We investigated the tunnel position and the incidence of intraoperative complications.
  
  
  METHODS
  The presented technique is anatomical single bundle ACL reconstruction using a semitendinosus graft (with or without the gracilis tendon). The tunnel was drilled via an additional medial portal. Rounded rectangular tunnels were created using a special dilator. Tibial tunnels were created using conventional rounded tunnels. Fixation was achieved using a suspensory device on the femoral side and a plate and screw on the tibial side.
  
  
  METHODS
  Fifty patients underwent this surgery, and intraoperative complications were investigated. The femoral tunnel positions were documented postoperatively from computed tomography scans using the quadrant method. The tibial tunnel positions (anterior-to-posterior, medial-to-lateral) were documented using intraoperative X-ray scans.
  
  
  RESULTS
  Only one patient had a partial posterior tunnel wall blowout. The femoral tunnel length varied between 30 and 40mm (mean, 34.9±3.3mm). All femoral and tibial tunnels were located within the area of the anatomical ACL insertions.
  
  
  CONCLUSIONS
  We did not experience any serious intraoperative complications during anatomical single bundle ACL reconstruction using a rounded rectangle dilator, and the resulting locations of the femoral and tibial tunnels were within the anatomical ACL footprint.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan. Electronic address: nakase1007@yahoo.co.jp.
authors.forename: Junsuke
authors.initials: J
authors.lastname: Nakase
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Toratani
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kosaka
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ohashi
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Hitoaki
authors.initials: H
authors.lastname: Numata
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oshima
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takata
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation*; D004867:Equipment Design; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: ACL reconstruction; Anatomical single bundle; Rounded rectangle