Abstract

Background: Posterior cruciate ligament (PCL) impingement following anterior cruciate ligament (ACL) reconstruction can often lead to post-operative graft instability and loss of knee range of motion. Purpose: The purpose of this study was to evaluate whether drilling a femoral tunnel through an anteromedial portal led to a decreased incidence of ACL-PCL impingement compared to trans-tibial methods during ACL reconstruction. Methods: Eight cadaveric knees were evaluated arthroscopically. Femoral tunnels used for ACL reconstruction were then drilled using both an anteromedial portal technique as well as a trans-tibial technique. Qualitative and quantitative comparisons of each technique#x2019;s ability to center a femoral tunnel in a non-PCL impinging position within the native ACL femoral footprint were then recorded. Results: Of eight tunnels drilled through an anteromedial portal, none showed signs of PCL impingement and all were centered in the native ACL footprint. Three tunnels (37.5%) drilled trans-tibially showed signs of potential PCL impingement starting at 90 degrees flexion, and all were displaced superior to the center of the native ACL footprint by an average of 3.25 mm. Conclusion: Femoral tunnels drilled through an anteromedial portal technique were consistently placed in the center of the ACL femoral footprint, and no potential impingement by the PCL was noted. Femoral tunnels drilled trans-tibially had a tendency to displace superiorly and three showed signs of impinging against the lateral border of the PCL.