Anatomic Single-bundle Anterior Cruciate Ligament Reconstruction Using the Flexible Drilling/Reaming system: A Preliminary Experience

Abstract

Introduction: The purpose of anatomic anterior cruciate ligament (ACL) reconstruction is to restore the normal function of the ACL. Therefore, the ACL should be reconstructed at its original footprint. There are many different methods to create the femoral tunnel, including the transtibial, transportal, and outside-in techniques. Each method has different benefits and limitations. Thus, we used the flexible reamer system to perform the anatomic ACL reconstruction. Materials and methods: From May 2014 to Feb 2015, 26 patients in our hospital received single-bundle ACL reconstructions using the flexible reamer system. Twenty men and 6 women with a mean age of 30.6 years were included. The EndoButton was applied for femoral site fixation and tibial site was fixed with the PLLA-HA interference screw and one post screw. After the operation, the patients' knee joints were protected with the range of motion (ROM) brace at zero degree for 2 weeks. The range motion of the brace was subsequently adjusted to 60, 90, and 120 degrees at the 2nd, 4th, and 6th postoperative week, respectively. Results: No major complications, including wound infection, vascular or nerve injuries, were reported in these patients. However, breakage of the flexible guidewire occurred in one patient, which was smoothly resolved subsequently. The average femoral tunnel angle was measured. Post-operative three-dimensional computed tomography scans were also performed to check the femoral tunnel aperture location. Conclusion: Individualized anatomic ACL reconstruction is essential for ACL-deficient patients. With the flexible reaming system, the surgeon can easily create the femoral tunnel at the anatomic position. However, the surgeons should ensure the durability and sharpness of the guidewires and reamers by prior to the procedures.