Fig 8.

Aiming for a flat femoral tunnel. (C) The insertion of the femoral guide primarily in line with the incision and in (D) (intraoperative view on a left knee from anterolateral), (I) (schematic drawing) oriented anatomically. (A) Arthroscopic view of the medial wall of the lateral femoral condyle with the first guidewire, described in the previous picture, and the femoral guide already in place from a lateral standard portal. The initial guidewire is inserted in the central hole of the guide and it is then oriented in line of the anatomic ACL insertion. Two other guidewires are drilled through the additional lateral holes in the femoral guide. They don't need to be drilled through the lateral cortex but about 30 mm (I). The femoral aimer is removed (B, arthroscopic view from a lateral standard portal; G, intraoperative view on a left knee in 110° of flexion from anterior) and the lateral 2 wires are overdrilled with a 4.5-mm drill bit to a depth of 25 to 30 mm (E, arthroscopic view from a lateral standard portal; H, intraoperative view on a left knee in 110° of flexion from anterior; J, schematic drawing) depending on the length of the femoral tunnel and the graft and afterwards removed. (F) Medial wall of the lateral condyle from a medial portal view, with the initial guidewire still in place and the 2 lateral drill holes.