Iatrogenic injury of posterolateral structures during femoral tunneling in anterior cruciate ligament reconstruction: A cadaveric study

Objective: Creating Femoral tunnel in Anterior Cruciate Ligament (ACL) reconstruction can be done through some
portal. Transportal technique commonly preferred by Orthopedic Surgeon. However, this technique may possess
some iatrogenic injury to knee structure especially in the posterolateral during the drilling. This study aim is to
describe the most susceptible injured posterolateral structure of the knee during femoral tunneling from trans
portal technique Anterior Cruciate Ligament (ACL) reconstruction.
Methods: Twenty knees from ten cadavers was examined. Anterior Cruciate Ligament (ACL) reconstruction was
simulated using the trans portal technique. Femoral drilling was performed with knee in 120 flexion. The cadaver
was dissected to identify the injured posterolateral structure during femoral tunneling. The data collected was
anatomy structure and the wound size.
Results: All Twenty knees were included in the study. 90% of injured structure was iliotibial band. The next most
common was plantaris (50%) dan gastrocnemius (45%) muscle. The other was biceps femoris muscle (20%). The
least common injury was vastus lateralis (5%). No injury was observed in Lateral Collateral Ligament (LCL),
popliteus tendon, and peroneal nerve.
Conclusion: Transportal technique during femoral drilling in Anterior Cruciate Ligament (ACL) reconstruction
does do damage to some of the posterolateral structure. The injury was considered minimal and may not result in
function deterioration. There is also no risk to common peroneal nerve.