Femoral interference screw placement through the tibial tunnel: A radiographic evaluation of interference screw divergence angles after endoscopic anterior cruciate ligament reconstruction

Fifty patients who underwent single-incision arthroscopically assisted anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone autograft were reviewed. All procedures were performed using a technique for placement of the femoral interference screw that reduced the divergence between the femoral interference screw and the femoral bone plug. This technique includes securing the femoral interference screw by placing the screw driver through the tibial tunnel, anterior to the tibial bone plug. Using this technique, 8% of our patients had significant femoral bone plug and interference screw divergence; however, no patients had a divergence angle of greater than 15 degrees in either the anteroposterior or lateral planes, None of our patients were noted to have divergence angles consistent with decreased pullout strength. We had no complications caused by screw driver placement, and we did not experience any graft injury. We believe that adequate femoral bone plug and interference screw alignment can be achieved by using this technique during single-incision endoscopic ACL reconstruction.