“Retrograde Technique” for Drilling the Femoral Tunnel in an Anterior Cruciate Ligament Reconstruction  Barton R. Branam, M.D., Kimberly A. Hasselfeld, M.S., C.C.R.P.  Arthroscopy Techniques  Volume 2, Issue 4, Pages e395-e399 (November 2013) DOI: 10.1016/j.eats.2013.06.002 Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) The left knee is the operative knee. The arthroscopic leg holder is placed as proximal as possible, and the nonoperative limb is out of the way as the hip and knee are flexed. The patient is placed as far distal as possible. (B) The ability to hyperflex the knee is shown before draping. (C) The anteromedial working portal is created as inferior and medial as possible without injuring the meniscus or the articular cartilage of the medial femoral condyle. This allows for drilling of the longest possible tunnel. Arthroscopy Techniques 2013 2, e395-e399DOI: (10.1016/j.eats.2013.06.002) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) The position at which the guide pin exits the thigh is noted. If it is too proximal, it should be repositioned before drilling the tunnel. (B) With the arthroscope in the central portal, the intra-articular location of the pin is re-evaluated with the knee in 90° of flexion as the flow and visibility are restored. Arthroscopy Techniques 2013 2, e395-e399DOI: (10.1016/j.eats.2013.06.002) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) The reamer can be passed independently into the joint without the knee hyperflexed. The arthroscope is in the lateral portal. (B) The cannulated low-profile reamer is passed into the notch. (C) The arthroscope is placed into the central portal as the knee is hyperflexed, and the Beath pin is passed retrograde back through the cannulated low-profile reamer. One should note that the visibility is slightly blurry as the knee is hyperflexed at this point, reducing flow. (D) Femoral tunnel. (E) Intact back and lateral wall. Arthroscopy Techniques 2013 2, e395-e399DOI: (10.1016/j.eats.2013.06.002) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions