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Arthrosc Tech. 2017 Feb 20;6(1):e227-e232. doi: 10.1016/j.eats.2016.09.028. eCollection 2017 Feb.

Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Modified Transtibial Technique.

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Department of Orthopaedic Surgery, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea.
Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea.


We present a technique for anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft with a modified transtibial technique. Our modified transtibial technique has the advantages of the conventional transtibial technique that is familiar to surgeons and that allows the press-fit fixing and enables us to make a relatively long femoral tunnel. To make the femoral tunnel at the anatomic position, the triangular, funnel-shaped bony trough was made to slip the eccentrically positioned guide pin into the anticipated anatomic center with a free-hand technique after marking the anatomic ACL footprint using a microfracture awl through the anteromedial portal. Gradual femoral reaming was performed with knee angle changes, which reduces the chances of posterior wall blowout, increases the femoral tunnel length, and avoids breakage of guide pin at the bending point. Our modified transtibial technique is anticipated to provide a more anatomic placement of the femoral tunnel during ACL reconstruction than the previous traditional transtibial techniques.

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