A comparison of the effectiveness of currently available instrumentation for radiusing bony tunnel exits in cruciate ligament reconstruction

Mode of failure analyses of explanted prosthetic ligaments and clinical MRI studies of autologous reconstructions have identified that the position of the exit of the tibial tunnel is critical for the survival of an intra-articular reconstruction of the anterior cruciate ligament. When drilling the tibial tunnel, the position of the exit must be positioned behind the roof and apex of the intercondylar notch in the extended knee if implant impingement is to be avoided. Inadequate radiusing of the exits of tibial and femoral tunnels is also likely to be another factor leading to localised rupture, or graft complications in this type of surgery. A prospective comparative study was performed to determine the effectiveness of existing instruments available for radiusing the drill hole exit. This has resulted in the development of a modified back radius cutter, which provides effective and consistent removal of sharp edges at the margins of bony tunnels. (C) 1999 Published by Elsevier Science B.V. All rights reserved.