Tibial Tunnel

Figure 6.51 shows the correct external position for the tibial guide. The tip of the Linvatec guide is placed 2-mm medial to the crest of the tibia and 5cm distal to the joint line. The guide is usually set at 55°. The tip of the guide should be adjacent to the medial collateral ligament. The oblique position will allow the positioning of the femoral guide in an oblique position (Fig. 7.8). The result of this is an oblique graft. This graft position has better long-term stability.

The tip of the guide is in the midline, 7mm anterior to the PCL (Fig. 6.52). The guide is inserted through the anteromedial portal, by turning it upside down. The knee is flexed to 90°. The surgeon should make sure to aim to bring the long graft passing wire out the antero-lateral thigh. The target zone is a 10-cm oval region just above the lateral suprapatellar pouch. Drill a K-wire through the guide into the joint. When the wire hits the guide, loosen it and let the K-wire advance. The guide wire should just touch the leading edge of the PCL (Fig 6.53).

Remove the guide. Ream over the K-wire with a 10 mm drill bit. Clean the interior tunnel site with the 5.5 mm resector. If necessary, chamfer the posterior rim with the chamfering device on the drill. There should be a 3- to 4-mm posterior wall between the tunnel and the PCL

Figure 7.8. The oblique position of the tibial tunnel allows the drilling of the femoral tunnel at the 11 or 1 o'clock position.
Figure 7.9. The position of the tibial tunnel.

(Fig. 7.9). Clean the exterior tunnel site with the 5.5-mm resector. This allows for easy passage of the graft. The video on the CD demonstrates the tunnel procedure.

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