This video demonstrates femoral and tibial tunnel creation for ACL reconstruction with patella tendon autograft. We utilize an anteromedial technique with a flexible reamer to create the femoral tunnel. The patella block is docked into the femoral tunnel in a retrograde fashion. A probe is used to facilitate graft passage to obtain appropriate graft orientation. We normally drill a 10mm femoral tunnel. Our patella graft is sized to a 9x20mm block. We avoid longer bone blocks to optimize graft passage. The graft is marked at its bone-tendon interface. The cortical portion of the bone block is oriented posteriorly. A cannulated titanium screw is placed via the anteromedial portal and placed anterior to the graft with the graft well protected. The knee is at 110-120 degrees of deflection during placement of the screw. The screw is typically a 7x20mm or 8x20mm screw depending on bone quality. It is critical to avoid screw divergence. This video details screw placement. Once the graft is docked into the femur, a sled is placed anterior to the graft for graft protection. A notcher is used to create a notch anterior to the graft to a depth of 30 to 35 millimeters. A cannulated screwdriver is used to position the guide wire anterior and parallel to the bone block. The screwdriver is removed and the guide wire left in place. The cannulated titanium screw is placed over the guide wire. Periodically, the guide wire is assessed to avoid incarceration of the guide wire during screw placement. These still images demonstrate the aforementioned steps.

ACL reconstruction

patella tendon autograft

femoral tunnel

anteromedial technique

tibial tunnel

cannulated titanium screw