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The Evolution of Femoral Tunnel Drilling in ACL Reconstruction: History, Current Practices, and Future Applications

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Abstract

Anterior cruciate ligament (ACL) reconstruction techniques have continued to evolve as our understanding of knee kinematics and ligamentous anatomy has developed. The major femoral tunnel placement techniques include over-the-top, outside-in, transtibial, anteromedial portal with rigid and flexible reaming, and retrograde reaming. Accurate tunnel placement can be achieved with any of the major drilling techniques (outside-in, transtibial, and anteromedial). Advances in technology have revolutionized our methods of practice and changed the way that we approach reconstructive surgery. Superior technology, such as flexible instruments and retrograde reamers, has enabled more accurate drilling of femoral bone tunnels within the ACL femoral footprint, which provides improved stability and knee kinematics. Long-term clinical and functional outcomes have yet to elucidate the preferred method of femoral tunnel drilling; however, there have been excellent short-term outcomes reported using the anatomic femoral tunnel with improved objective and subjective measures when compared to non-anatomic femoral tunnels.

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  1. Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Hanna House 5043, Cleveland, OH, 44016, USA

    Christopher J. McMellen, Jason G. Ina, Jacob G. Calcei, Donald G. Goodfellow & James E. Voos

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CJM contributed to formal analysis, investigation, and writing of the original draft. JGI contributed to formal analysis, investigation, and writing of the original draft. JGC contributed to conceptualization, data curation, and writing—review and editing. DGG contributed to conceptualization, project administration, and writing—review and editing. JEV contributed to conceptualization, methodology, project administration, and writing—review and editing. All authors read and approved the final manuscript.

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JEV has received educational support and non-consulting fees from Arthrex, consulting fees from DePuy and hospitality payments from Medical Device Business Services. The remaining authors have no conflicts of interest to disclose.

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McMellen, C.J., Ina, J.G., Calcei, J.G. et al. The Evolution of Femoral Tunnel Drilling in ACL Reconstruction: History, Current Practices, and Future Applications. SN Compr. Clin. Med. 4, 195 (2022). https://doi.org/10.1007/s42399-022-01278-y

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