Surgical Adjustment of the Guide Pin to Perform a Correct Tibial Tunnel in Anatomical Anterior Cruciate Ligament Single-Bundle Reconstruction Bharath.

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Surgical Adjustment of the Guide Pin to Perform a Correct Tibial Tunnel in Anatomical Anterior Cruciate Ligament Single-Bundle Reconstruction Bharath S. Kumar, M.D., Renato Andrade, B.Sc., Ana Leal, M.Sc., André Sarmento, M.D., Hélder Pereira, M.D., Nuno Sevivas, M.D., João Espregueira-Mendes, M.D., Ph.D. Arthroscopy Techniques Volume 5, Issue 4, Pages e757-e762 (August 2016) DOI: 10.1016/j.eats.2016.03.002 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Identification and measurement of the tibial anterior cruciate ligament footprint—arthroscopic view (A) and phantom representation (B). The dimension marker shows the length of the footprint. Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Inaccurate eccentric exit of the guide pin—arthroscopic view (A) and phantom representation (B). The arrows indicate the eccentric exit direction of the guide pin. Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 A small tunnel is made with a 4.5-mm reamer—arthroscopic view (A) and phantom representation (B). The smaller dotted circle indicates the new 4.5-mm tunnel in relation to the footprint size (larger circle). Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Adjustment of the guide pin to the correct position of the center of the tibial footprint—arthroscopic view (A) and phantom representation (B). Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Correction of the guide pin within the north, south, west, and east poles. Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Fixation of the guide pin to the femoral roof top—arthroscopic view (A) and phantom representation (B). The arrows indicate the fixation of the guide pin. Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Overdrill to achieve the final tunnel in the anatomic position—arthroscopic view (A) and phantom representation (B). The circle indicates the final tunnel with the same size as the tibial footprint. Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 Representation of adjusting the eccentrically placed guide pin in the anterior cruciate ligament tibial footprint. Incorrect position of the guide pin (A), small tunnel made with a 4.5-mm reamer (B), adjustment of the guide pin to the center of the footprint (C), and overdrill to achieve the final tunnel in the anatomic position (D). Arthroscopy Techniques 2016 5, e757-e762DOI: (10.1016/j.eats.2016.03.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions