AANA Middle East Arthroscopy Master Course (International)-Things I Do to Make ACL Reconstruction Successful and Easy

Things I Do to Make ACL Reconstruction Successful and Easy

Pdf Summary

Dr. Robert Hunter, Director of the Orthopedic Sports Medicine Center in Salida, Colorado, presented key techniques to optimize anterior cruciate ligament (ACL) reconstruction at the AANA Middle East Arthroscopy Master Course in Dubai in 2019. His approach emphasizes anatomical accuracy and procedural efficiency, focusing on femoral tunnel preparation, knee positioning, reaming techniques, and fixation methods.<br /><br />Hunter advocates using an outside-in (OI) drilling technique to prepare the femoral tunnel, as evidence shows it best replicates the ACL footprint compared to transtibial (TT) or anteromedial portal (AMP) techniques. The OI method, guided by computer navigation and 3D femur mapping, positions the pin at 60° from perpendicular to the femoral axis and 20° from the transepicondylar axis. It creates a longer, oval-shaped femoral tunnel with a high/anterior exit and can be performed at 90° knee flexion using a drill guide.<br /><br />Throughout the surgery, Hunter keeps the knee flexed at 90°, optimizing visualization and access through the anterolateral portal (ALP) while working via the AMP. He recommends flexible reamers for femoral drilling to create an elliptical tunnel that closely matches the ACL’s natural origin.<br /><br />Regarding fixation, Hunter identifies tibial fixation as the weak link and stresses its reinforcement. He prefers interference screw fixation using a drill size 1-2 mm smaller than the graft, dilating the tunnel to graft size, and inserting a screw about 1 mm larger than the graft diameter—for example, drilling 6 mm for an 8 mm graft, dilating to 8 mm, and using a 9 mm screw—to secure a strong fit.<br /><br />Finally, Hunter notes the limited benefit of patient follow-up beyond six months post-surgery. His comprehensive technique aims to make ACL reconstruction both successful and surgeon-friendly by emphasizing anatomical precision and robust fixation.

Keywords

ACL reconstruction

anterior cruciate ligament

orthopedic sports medicine

outside-in drilling technique

femoral tunnel preparation

knee flexion 90 degrees

anterolateral portal

flexible reamers

interference screw fixation

tibial fixation reinforcement