Specialized Toolkit Series: ACL Reconstruction-Drilling the Tibial Tunnel

Drilling the Tibial Tunnel

Video Transcription

Video Summary

Dr. Patrick Joyner explains two techniques for drilling the tibial tunnel in ACL reconstruction: the outside-in (trans-tibial) and inside-out (retrograde). The outside-in method involves starting from the outside tibia and drilling inward, with fluted reamers recommended for bone plug grafts and acorn reamers for flexibility in tunnel direction. The inside-out method uses a retrograde reamer, placing the guide on the ACL footprint and drilling backward. Hybrid reaming can adjust tunnel trajectory if needed. Dr. Joyner prefers the outside-in technique and emphasizes the importance of smooth tunnel creation for successful graft passage.

Asset Caption

Patrick Wakefield Joyner, M.D., M.S., FAANA

Keywords

ACL reconstruction

tibial tunnel

outside-in technique

inside-out method

Dr. Patrick Joyner