Debate: A 17-Year-Old Lacrosse Player with an Isolated ACL Tear - - PowerPoint PPT Presentation
Debate: A 17-Year-Old Lacrosse Player with an Isolated ACL Tear Pro: Transtibial Drilling Works: I Am Not Changing I Will Show You the Results David R. McAllister, MD Professor and Chief, Sports Medicine Service Department of Orthopaedic
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David R. McAllister, MD Professor and Chief, Sports Medicine Service Department of Orthopaedic Surgery David Geffen School of Medicine at UCLA Head Team Physician, Los Angeles Lakers Associate Head Team Physician and Director of Orthopaedic Surgery for UCLA Department of Athletics
Biomet: IP royalties; Paid consultant Elsevier: Publishing royalties, financial or material
Musculoskeletal Transplant Foundation/Conmed:
Ossur: Paid presenter or speaker Smith & Nephew: Unpaid consultant
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Lower femoral tunnel position Transtibial vs. AM portal creation of femoral
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A number of
However, is lower
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Does placing the femoral tunnel
No change in pivot-shift,
The rationale for placing the
Markolf et. al. AJSM 2010 Markolf et. al. JOR 2002
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Recent Clinical Study Report of the Danish
Wagner et. al. KSSTA
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There are multiple
However, many of the
Bowers et al,
Bedi et al, Arthroscopy,
Gadikota, AJSM 2012
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The femoral tunnel can be positioned in a
Piasecki et al, AJSM, 2011
The key is to place the femoral tunnel in the
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As deep in the notch as
1:30 or 10:30 o’clock position
Tunnel that is too vertical
Lower is not always better!
Tunnel that is too low results in
13 Femoral Tunnel
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Free hand technique Femoral “over the top” aimer
Isometry Direct Fibers Eccentric/Equidistant Anatomic Low tension
Midway between PCL and
1 mm posterior wall
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Isometry Direct Fibers Eccentric/Equidistant Anatomic Low tension
Midway between PCL
1 mm posterior wall
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Within native ACL
Adjacent to anterior
In between the tibial
Avoid notch/roof
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