Pitfalls in Single-Bundle Anterior Cruciate Ligament Reconstruction with the Flexible Reamer System by Seung-Yup Lee, Jae-Gyoon Kim, Ki-Mo Jang, and Hong-Chul.

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Presentation transcript:

Pitfalls in Single-Bundle Anterior Cruciate Ligament Reconstruction with the Flexible Reamer System by Seung-Yup Lee, Jae-Gyoon Kim, Ki-Mo Jang, and Hong-Chul Lim JBJS Case Connect Volume 4(4):e95 October 22, 2014 ©2014 by The Journal of Bone and Joint Surgery, Inc.

If the tibial footprint of the ACL is completely debrided, the curved femoral drill guide can rest comfortably on the tibial plateau with a 45° superolateral trajectory. Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Bulky tibial remnants of the ACL (arrow) may interfere with the curved femoral drill guide and not allow it to rest at a superolateral trajectory of 45° (dashed arrow). Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

In the patients described in Case 1 and Case 2, 6-mm (top) and 7-mm (bottom) flexible reamers, respectively, were broken. Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Breakage of the flexible guide pin in Case 2. Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

The broken 7-mm flexible reamer was removed through the anteromedial portal with use of wire- holding forceps. Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Postoperative CT reveals posterior wall blowout (arrow) in Case 1. Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

An epiphyseal scar (arrowheads) could cause increased resistance (arrow) during femoral reaming. Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

As noted, posterior cortex blowout occurred in Case 1. Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

A change in knee flexion after flexible pin placement (arrowheads) would cause acute bending of the flexible guide pin (arrows). Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.

During flexible pin placement (arrowheads), a change in the position of the curved drill guide (closed black arrow) might cause acute bending of the flexible pin (open arrows). Seung-Yup Lee et al. JBJS Case Connect 2014;4:e95 ©2014 by The Journal of Bone and Joint Surgery, Inc.