Femoral Tunnel Drilling in ACL Surgery

50 Pages·2016·3.27 MB·English

by  Mark Clatworthy

Jeffrey R. Dugas, MD
Birmingham, Al
Mark Clatworthy
Tim Roberts
Middlemore Hospital
Auckland
New Zealand
No disclosures related to the subject matter

of this presentation.
Significant changes in the way ACL surgery

is performed
 Double Bundle
 Various Femoral Tunnel Drilling techniques
 Addition of various biologic “enhancements”
Basic science supports the fact that the ACL

is comprised of two “bundles” of fibers
which function in conert.
Idea of recreating two bundles certainly

seems reasonable given the native anatomy
Clinically challenging technique to get two

grafts at the native origin of the ACL

Clinical results have (to date) failed to show

superiority or reliable equivalence to large
scale clinical studies of single bundle ACL
reconstruction.
Many early adopters of this technique have

returned to single bundle ACL
reconstruction.

Transtibial drilling was the most common

technique until 5-10 years ago.
 Evidence that transtibial drilling led to
unacceptable position of the femoral tunnel
 Possible cause of early failure of ACL graft due
to vertical orientation.
 Medial Portal Drilling espoused as the solution
to more accurately recreate the normal
anatomic origin of the ACL.
Miller et al and others 2010-2014

 “It is borderline malpractice to drill through the
tibial tunnel.”