Choosing the correct position for the tibial tunnel is crucial to the rest of the operation. The landmarks are external surface of the tibia, 4 cm from joint line, 2cm medial to tibial tubercle; inside, 7mm anterior to the leading edge of the PCL, in the midline.
The Linvatec tibial guide is set at 55° (Fig. 6.51). The guide is inserted through the anteromedial portal, by turning it upside down. The knee
is flexed to 90°. The distal point of the guide is positioned 2 cm medial to the tubercle and 4 cm from the joint line.
The tip, as shown in Figure 6.52 is placed in the midline between the spines and 7 mm anterior to the PCL. Drill a K-wire (Fig. 6.53) through the guide into the joint. When the wire hits the guide, loosen it and let the wire advance. It should just touch the leading edge of the PCL. Remove the guide. Ream over the K-wire with a 10-mm drill bit. Clean the interior tunnel site with the 5.5-mm Gater blade. If necessary, chamfer the posterior rim with the chamfering device on the drill. Clean the exterior tunnel site with the 5.5-mm Gater blade. This allows for easy passage of the graft. In the photo, this K-wire is in a good position. The wire is in the middle of the ACL stump, approximately 7 mm in front of the PCL, in the midline and just touching the edge of the PCL. The video on the CD demonstrates the tunnel procedure.
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