The use of the 70° arthroscope for anatomic femoral and tibial tunnel placement and tunnel viewing in anterior cruciate ligament reconstruction

Abstract

The use of the 70° arthroscope in knee surgery is not a new concept, and it is frequently used in posterior cruciate ligament reconstruction. There are previous reports of its use in anterior cruciate ligament surgery, but it has not achieved routine use. With the move toward anatomic anterior cruciate ligament reconstruction, it is recognized that accurate tunnel placement is vital for a good clinical outcome. Visualization of the femoral and tibial footprints can be variable with the use of only an anterolateral viewing portal, and it may be necessary to create accessory anteromedial portals, which can cause problems with instrument crowding. Overall, the 70° arthroscope provides an excellent view of the femoral and tibial footprints and a view of the full length of the femoral and tibial tunnels through a single anterolateral viewing portal.

Fig 1

Stryker camera covered with Clinicon quick-change camera drape (left) and Olympus 30° and 70° arthroscopes (right). This allows rapid changing between the 30° and 70° arthroscopes and the need for only 1 camera.

Fig 2

(A) Femoral footprint view with 30° arthroscope from AL portal showing inadequate visualization of femoral footprint. (B) Femoral footprint view with 30° arthroscope from anteromedial portal. (C) Femoral footprint view with 70° arthroscope from AL portal. Excellent visualization of the femoral footprint is achieved.

Fig 3

(A) Bird’s-eye view of the tibial footprint through the 70° arthroscope from the AL portal, showing the relation of the PBAHLM (arrow) with the center of the tibial stump (marked with diathermy). (B) View of the same patient using the 30° arthroscope from the AL portal, which does not show a clear relation between the PBAHLM and the tibial stump because of the more oblique view obtained with the 30° arthroscope.

Fig 4

(A) View of femoral tunnel with 70° arthroscope from AL portal. (B) Tibial tunnel viewed through 70° arthroscope from AL portal. (C) Tibial tunnel view in revision ACLR with 70° arthroscope through AL portal. One should note the ability to inspect the entire tunnel, which is particularly important if using an interference screw as femoral fixation and is also useful in revision ACLR.