ACL Reconstruction

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ACL Reconstruction

ACL reconstruction has been proven to be a very effective method of surgical treatment of symptomatic ACL instability. Traditional ACL reconstruction performed by using the transtibial method did have a slightly higher rate of late-onset of arthritis as a result of the nonanatomic placement of the ACL. It is well known that anatomical reconstruction of the ACL reproduces the normal anatomy of the knee and thus results incomplete and full stability and function of the knee. To reach the anatomic location on the femur, it is necessary to make an additional skin incision on the inner side of the knee – the accessory medial portal. If you make the femoral tunnel, with the knee at 90° of flexion, the resultant tunnel length achieved is usually less than 30 mm. So in order to create a slightly longer femoral tunnel, it is necessary to drill the femoral tunnel in about 120° or 130° of flexion.

This poses certain specific problems like:-

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• The vision may be obscured by the presence of a thick fat pad, which may then necessitate excessive fat pad resection.

• There may be inadvertent scuffing of the articular cartilage of both the medial femoral condyle as well as the patella.
• There is difficulty in the visualization of the anatomic insertion point of the ACL on the femur.

Some Of The Disadvantages Of The Trans Portal Method Of Doing ACL Reconstruction Are:-

• Critically short sockets < 20mm
• Posterior or lateral wall blowout
• The inferior exit of wire laterally endangering soft tissues
• Iatrogenic chondral damage to MFC
• Difficult visualization of anatomy with hyper flexed position
• Bending of the guidewire in a hyper flexed position
• Difficulty with graft passage and fixation (Lubowitz & Arthroscopy)

In order to overcome these difficulties, we use the Clancy flexible drill guide system. This consists of a flexible guidewire and flexible drill bits which can be utilized to undertake an ACL reconstruction by the anatomic method by keeping the knee at 90° flexion.

This has several advantages:-

• There is no scuffing of the joint surface.
• You get along the femoral tunnel and this will enable you to use any form of fixation – aperture or a suspensory, very easily.
• The tunnel that exists is much far away from the lateral collateral ligament and the peroneal nerve.
• Visualization is excellent since knee hyperflexion is not required.
• No offset guides are required to be used for tunneling, thereby reducing the time and expense of instrumentation.
• There is less risk of bending guide wires since the knee is at 90