ABSTRACT
Six fresh-frozen cadaveric knees were utilized to evaluate which lateral anatomic
structures were at risk when using an outside-in, percutaneous technique for placing
guide pins for transepiphyseal reconstruction of the anterior cruciate ligament. With
knees in the standard arthroscopic position, guide pins were placed percutaneously
into the centers of the anteromedial and posterolateral bundle footprints using a
transepiphyseal approach. After guide pin placement, the lateral aspect of the knee
was dissected, and the proximity of each guide pin to the important lateral anatomic
structures was measured. The current study has shown that multiple anatomic structures
are at risk when using a percutaneous approach for guide pin placement during transepiphyseal
anterior cruciate ligament reconstruction. The anteromedial bundle guide pin put the
gastrocnemius tendon and lateral collateral ligament at risk as it was, on average,
0.76 and 2.4 mm from these structures, respectively. The posterolateral bundle guide
pin was on average 0.7 and 1.1 mm from the lateral collateral ligament and popliteus
tendon, respectively. The transepiphyseal technique is a promising option for anatomic
reconstruction of the ACL in skeletally immature patients. When using an outside-in
technique, a mini-open technique should be used to reach the lateral femoral cortex.
When using inside-out, retrograde drilling devices, violation of the lateral cortex
should be avoided to preserve the lateral anatomic structures.
KEYWORDS
Anterior cruciate ligament - reconstruction - femoral tunnel - transepiphyseal - skeletally
immature
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Lutul D FarrowM.D.
Department of Orthopaedic Surgery, University of Arizona College of Medicine
Arizona Institute for Sports Medicine, 2800 East Ajo Way, Tucson, AZ 85713
eMail: lutulfarrowmd@yahoo.com
