Femoral Tunnel

To drill the femoral tunnel, the Bullseye (Linvatec, Largo, FL) femoral aiming guide is placed through the tibial tunnel. This means that the tibial tunnel must be in the correct position and at the correct angle or it will be impossible to place the femoral tunnel correctly. The tunnels

Figure 6.53. The ideal position for the tibial guide wire.

are drilled according to the graft measurement, that is, 7 or 8 mm. The physician should not leave the graft soaking in saline, as it may swell and make passing difficult. The graft should simply be wrapped in a surgical sponge.

The femoral tunnel is drilled through the tibial tunnel with the use of the femoral aiming guide (Fig. 6.54). The Bullseye guide is inserted through the tibial tunnel, the flare of the guide placed over the top of the femoral condyle, and the guide aimed at the 11 or 1 o'clock position (Fig. 6.55). A long, guide-passing wire is drilled into the femur and retrieved through the anterolateral thigh. The surgeon should avoid placing the femoral tunnel in a vertical position. Howell has shown that the vertical graft provides a-p stability, but not rotational stability at 30° of knee flexion. The oblique position of the graft is preferable to the vertical graft position.

The guide wire (Linvatec, Largo, FL) is overdrilled with the same size C-reamer as used in the tibial tunnel. It is important to make a footprint on the condyle by drilling only half of the head of the drill bit into the bone. The drill bit is retracted and the footprint examined to determine if it is in the correct position (Fig. 6.56 and Fig. 6.57). The video on the CD illustrates this procedure.

Figure 6.54. The transtibial Bullseye femoral aiming guide.
Figure 6.56. The footprint made by the drill bit.
Figure 6.57. This demonstrates the ideal posterior wall of 1-2 mm.

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