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What does it mean to have ACL reconstructive surgery with "independent drilling." This is the term my surgeon used when dictating her report on me. The surgery is next week and I won't see the surgeon before then to ask so I thought I'd check with you and see what you can tell me.
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Surgeons are always looking for ways to improve surgical technique in hopes of better outcomes for their patients. In the case of anterior cruciate ligament (ACL) reconstruction, there's been a slight shift in how the tunnels are drilled through the bone for the graft tendon. Along with that change comes the ability to place the graft in a more natural position. The net result is a more anatomic reconstruction.
It is always the case that ACL surgery is done with an eye toward restoring all the damaged structures to as normal as possible. That way, the patient has a fighting chance of returning to normal function with a stable knee. But it is also agreed that the anatomy of the anterior cruciate ligament is complex and difficult to mimic.
One of the more difficult aspects of ACL reconstructive surgery has always been drilling through the tibia (lower leg bone) in order to thread the tendon graft through the hole to the right spot for attachment. This type of tunnel is called a transtibial tunnel.
The tunnel drilling technique used until recently often placed the graft in a vertical (up and down) position. As a result of the slightly off-anatomic position, the knee could end up unstable even though the graft was intact.
Over the years surgeons have tried different ways to approach this problem. They have tried changing the way the second tunnel is constructed. This second tunnel is through the femur (thigh bone). They have tried making the tibial tunnel up higher and shorter. And they have used different starting points for the tibial tunnel along the medial side of the knee (side closest to the other knee).
None of these efforts has proved successful. Problems with joint instability, altered joint kinematics (movement), and early degenerative arthritis have occurred. The latest trend has been to drill the two tunnels separately from each other rather than using the entrance to one tunnel (tibial tunnel) to drill the second (femoral) tunnel. This approach is referred to as independent drilling of the tibial and femoral tunnels. The tunnels and subsequent graft line up in a more anatomic center.
Results of studies so far suggest that this more anatomic approach helps improve rotational stability of the knee. Clinical studies of this independent drilling method have confirmed the improved results with shorter recovery time, earlier return to sports activity for athletes, and fewer failed ACL reconstructive surgeries.
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