Tibia Rotational Technique to Drill Femoral Bone Tunnel in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Genya Mitani, M.D., Ph.D.,

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Tibia Rotational Technique to Drill Femoral Bone Tunnel in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Genya Mitani, M.D., Ph.D., Tomonori Takagaki, M.D., Kosuke Hamahashi, M.D., Nagatoshi Kaneshiro, M.D., Ph.D., Kenji Serigano, M.D., Ph.D., Takashi Maeda, M.D., Yutaka Nakamura, M.D., Joji Mochida, M.D., Ph.D. Arthroscopy Techniques Volume 3, Issue 4, Pages e495-e499 (August 2014) DOI: 10.1016/j.eats.2014.05.009 Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Marking of correct point of AM and PL femoral bone tunnels with thigh in horizontal position. (B) The guide pin for the PL tibial bone tunnel should be inserted from the anterior border of the superficial medial collateral ligament to the center of the PL tibial insertion site at an angle of 30° to 35° in the coronal plane. Arthroscopy Techniques 2014 3, e495-e499DOI: (10.1016/j.eats.2014.05.009) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 2 Achievement of insertion through PL tibial tunnel of both PL femoral tunnel guide pin in neutral position and AM femoral tunnel guide pin at external rotation position of lower leg. Arthroscopy Techniques 2014 3, e495-e499DOI: (10.1016/j.eats.2014.05.009) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) When it is difficult to reach the mark with the rigid guide pin, (B) insertion of a 2.4-mm flexible passing pin using the narrow curved TR technique guide was achieved. (C) Bone tunnels and sockets measuring 4.5 mm in diameter for the graft were created with the Clancy Flexible Drill system. (D) In these situations, our special flexible depth gauge allows easy measurement of the length of the bone tunnels. Arthroscopy Techniques 2014 3, e495-e499DOI: (10.1016/j.eats.2014.05.009) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 4 Both the AM and PL femoral bone tunnels were created in the anatomic position behind the resident's ridge in all cases, without the occurrence of posterior wall blowout, as shown in a 3-dimensional computed tomography scan. Arthroscopy Techniques 2014 3, e495-e499DOI: (10.1016/j.eats.2014.05.009) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions