The femoral tunnel view test during ACL reconstruction can ensure tunnel integrity.

Objective: Violation of the posterior femoral cortex commonly referred to as posterior wall blowout, can be a devastating intraoperative complication in anterior cruciate ligament reconstruction (ACLR) and can lead to loss of graft fixation or early graft failure. This study describes and analyzes whether the femoral tunnel view test can ensure the integrity of the femoral tunnel during ACLR.

Methods: Intraoperative femoral tunnel integrity using the 360° arthroscopic view test was performed in 584 ACLR patients between 2014 and 2016. Posterior wall blowouts were described by their location along the femoral tunnel (i.e., near the aperture or more proximal) and by the depth of the tunnel blowout (<3 mm, 3-5 mm, >5 mm), corresponding to the length of the posterior cortical wall of the violated femoral tunnel. The time spent for the test was measured during ACLR. Complications related to the femoral tunnel view test were also evaluated.

Results: The femoral tunnel view test was performed in all 584 patients. In 12 patients (1%), the femoral tunnel presented a posterior cortical blowout that did not extend beyond 3 mm. Only four patients (0.6%) presented posterior wall blowout that extended beyond 5 mm. The time for the test was 40 s (±20 s). No complications related to the test were reported.

Conclusion: The femoral tunnel view test is effective for ensuring the integrity of the femoral tunnel during ACL reconstruction, without increasing the surgical time and without an increase in the complications rate.

Clinical Relevance: The femoral tunnel view test is a quick and straightforward test able to provide an adequate view of the patient's anatomy to ensure tunnel integrity during ACLR.