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This can be accomplished by inserting a guide pin (for starter reamer) from the center of the knee adding proximally to the identified point on the cortex.
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Then, we inserted a guide wire into the femur.
Based on this anatomical sub-study, we developed a quantitative clinical technique to insert a guide wire at the averaged center for anatomic double-bundle ACL reconstruction.
The surgeon inserted a guide wire at the center of the PL bundle attachment on the femur through the tibial tunnel.
The reasons may include that the previous studies did not use any quantitative techniques to insert a guide wire to create the femoral AM tunnel.
Anatomic double-bundle ACL reconstruction was carried out with the previously reported procedure [ 15, 18] including the above-described quantitative surgical technique to insert a guide wire.
Based on these data, we developed a technique to insert a guide wire at this point, using a 5-mm offset guide at the "over-the-top" portion of the lateral condyle, and we rotated the offset guide so that the tip of a guide wire inserted through the guide was aimed at the "1 30" or "10 30" o'clock orientation in the arthroscopic visual field.
In addition, we should note that the 2-dimensinal coordinate systems cannot be used when a surgeon inserts a guide wire into the averaged center of the AM bundle attachment in an arthroscopic visual field.
We conducted a prospective evaluation study with patients who underwent anatomic double-bundle ACL reconstruction using the above-described quantitative technique to insert a guide wire for AM bundle reconstruction.
Namely, the results enabled us to develop the quantitative guideline to insert a guide wire at the averaged center of the direct attachment of the AM bundle midsubstance fibers for anatomic double-bundle ACL reconstruction.
Concerning anteromedial (AM) bundle reconstruction, however, no quantitative clinically available methods to insert a guide wire at the center of the direct attachment of the AM mid-substance fibers have been reported to date.
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