Anteversion and length of the femoral tunnel in ACL reconstruction: in-vivo comparison between rigid and flexible instrumentation

Background Due to it being tangential to the distal femoral axis, the anteromedial portal presents significant risk of causing iatrogenic damage, and of producing tunnels that are too short for optimal osseointegration. Flexible reamers were developed to eliminate the need for knee hyperflexion and offer better-controlled orientation of the femoral tunnel. We aimed to compare the anteversion and length of femoral tunnels drilled using flexible reamers to those drilled using rigid reamers. Methods Between May 2012 and December 2013, all patients receiving ACL reconstruction performed by one surgeon were operated on using either a rigid or a flexible reamer from the same supplier (Versi-Tomic (R) system, Stryker, Kalamazoo, Michigan). The height of each patient was recorded, and the length and anteversion of the femoral tunnels were measured intra-operatively and on true lateral radiographs, respectively. Results Thirty-seven patients underwent operations using the rigid instrumentation, and 43 using the flexible instrumentation. There was no statistically significant difference between the two groups in either sex or height (p = n.s.). The patients operated on using the rigid instrumentation had tunnels anteverted by 18.6 degrees +/- 6 degrees and 33.6 +/- 2.9 mm long. Those operated on using the flexible instrumentation had tunnels anteverted by 40 degrees +/- 2 degrees and 41.1 +/- 3.57 mm long. Both anteversion and tunnel length were significantly greater for tunnels drilled using the flexible instrumentation (p < 0.001). Conclusions This study demonstrated that flexible reamers produce significantly more anteverted and longer femoral tunnels during ACL reconstruction than rigid reamers. Clinical studies remain necessary to assess the outcomes of ACL reconstruction using flexible reamers.