Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2017; 8(5): 379-384
Published online May 18, 2017. doi: 10.5312/wjo.v8.i5.379
Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling
Matthew Lacey, Joseph Lamplot, Kempland C Walley, Joseph P DeAngelis, Arun J Ramappa
Matthew Lacey, Joseph Lamplot, Kempland C Walley, Joseph P DeAngelis, Arun J Ramappa, Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
Author contributions: Lacey M, Lamplot J, Walley KC, DeAngelis JP and Ramappa AJ contributed equally to this technical note.
Institutional review board statement: This study was reviewed and approved for publication by our Institutional Reviewer Board at Beth Israel Deaconess Medical Center, Boston, MA.
Informed consent statement: This retrospective study design did not require informed consent, as deemed appropriate by our institution’s ethics committee/IRB. Had this been deemed necessary, all study participants or their legal guardian would have been provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Arun J Ramappa, MD, Chief, Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, United States. aramappa@bidmc.harvard.edu
Telephone: +1-617-6673940 Fax: +1-617-6672155
Received: October 26, 2016
Peer-review started: October 28, 2016
First decision: December 13, 2016
Revised: February 3, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 18, 2017
Processing time: 198 Days and 11.9 Hours
Core Tip

Core tip: The presence of retained hardware presents a challenge for surgeons treating patients with knee instability. In anterior cruciate ligament (ACL) reconstruction, intramedullary (IM) nails may confound tunnel placement, making removal of hardware necessary, unless techniques are adopted to allow for anatomic placement of the graft. We strongly recommend delaying the ACL graft harvest until creation of the femoral tunnel has been successful in these settings. Although unlikely when using anteromedial portal drilling, if the IM rod needs to be removed for anatomic graft placement but cannot be removed, the ACL reconstruction may have to be delayed until this issue is addressed.