An Alternative Technique to Avoid Injury to the Medial Femoral Condyle When Reaming the Femoral Tunnel During Anterior Cruciate Ligament Reconstruction

Contemporary anterior cruciate ligament reconstruction attempts to replicate the anatomical insertion sites on both the femoral and tibial sides to restore knee stability. Creation of the femoral tunnel by independently reaming through an anteromedial portal may allow surgeons to more reproducibly place the tunnel within the anatomic femoral footprint relative to a transtibial approach. However, inherent to the technique is the risk of iatrogenic injury to the articular cartilage of the medial femoral condyle as the reamers are passed adjacent to the condyle. This is particularly an issue with the use of standard nonflexible guide pins and reamers, which are placed with the knee in hyperflexion. We describe a relatively straightforward technique that can be used with standard equipment and that can be quite useful in avoiding this pitfall of the transportal approach.