Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 25, Issue 5 , Pages 563-564, May 2009

Author's Reply

Taos Orthopaedic Institute, Taos, New Mexico

Article Outline

 

Dear Dr. Shneider,

Thank you for your interest in the technical note “Anteromedial Portal Technique for the Anterior Cruciate Ligament Femoral Socket: Pitfalls and Solutions.”1 I respect the fact that you have had 25 years' experience with the technique. While you are not the first to remind readers and me that, in addition to the options of ACL femoral cortical suspensory button fixation and ACL femoral interference screw fixation, the ACL femoral Transfix Pin (Arthrex, Naples, FL) is an alternative method for graft fixation,2 I thank you for this reminder.

I have no experience with freehand technique for ACL femoral or tibial tunnel preparation. Because accurate tunnel placement is vital to ACL reconstruction outcome,3 my preferred technique is guided tunnel placement. It is possible that transtibial drilling may result in poor femoral socket position; however, based on his legendary reputation, I don't imagine that Tom Rosenberg achieved poor socket position frequently. Current research suggests that attention to reproducible landmarks during transtibial drilling may result in a well-positioned graft.4

You offer interesting and speculative logic with regard to the development of the growing interest in double-bundle ACL reconstruction. This was not the purpose of my technical note, but there has been speculation on this topic recently published.5

You conclude that, because of the challenges of transtibial drilling, I should consider a change to AM portal drilling. Here, it sounds as if we are on the same page. The purpose of my article was to consider exactly that change. Perhaps though, in addition, you are suggesting I should consider a change to the ACL femoral Transfix Pin technique. In the context of all the recent and technically challenging changes in ACL technique that I have considered,1, 6, 7 I allow that your idea of my switching to ACL femoral Transfix Pin technique is daunting. However, based on your experience, I will respectfully consider your recommendation. Thank you again.

Sincerely,

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References 

  1. Lubowitz JH. Anteromedial portal technique for the anterior cruciate ligament femoral socket: Pitfalls and solutions. Arthroscopy. 2009;25:95–101
  2. Smith PA. An alternative method for “all-inside” anterior cruciate ligament reconstruction. Arthroscopy. 2007;23:451;(letter).
  3. Fineberg MS, Zarins B, Sherman OH. Practical considerations in anterior cruciate ligament replacement surgery. Arthroscopy. 2000;16:715–724
  4. Raffo R, Pizzarello P, Richmond J, Pathare N. A reproducible landmark for the tibial tunnel origin in anterior cruciate ligament reconstruction: Avoiding a vertical graft in the coronal plane. Arthroscopy. 2008;24:843–845
  5. Lubowitz JH, Poehling GG. Techniques in double-bundle anterior cruciate ligament reconstruction: As simple as ABC, or putting the cart before the horse?. Arthroscopy. 2008;24:1089–1091
  6. Lubowitz JH. No-tunnel anterior cruciate ligament reconstruction: the transtibial all-inside technique. Arthroscopy. 2006;22:900.e1–900.e11
  7. Smith P, Schwartzberg R, Lubowitz JH. No tunnel 2-socket technique: All-inside anterior cruciate ligament double-bundle retroconstruction. Arthroscopy. 2008;24:1184–1189

PII: S0749-8063(09)00141-8

doi:10.1016/j.arthro.2009.02.015

Refers to article:

  • The Anterior Medial Portal

    David Shneider
    Arthroscopy: The Journal of Arthroscopic and Related Surgery May 2009 (Vol. 25, Issue 5, Page 563)

Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 25, Issue 5 , Pages 563-564, May 2009

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