Direct Arthroscopic Visualization of Anterior Cruciate Ligament Femoral Cortical Button Using Guide Pin Sleeve Technique to Confirm Appropriate Flipping Inside the Knee Joint

The anterior cruciate ligament (ACL) TightRope RT/BTB (Arthrex, Naples, FL) is an adjustable-loop device with a button used in ACL reconstruction. Malposition of the ACL TightRope RT/BTB button (3.5 mm × 13 mm) can be a complication. We describe a safe and simple method using the 2.4-mm guide pin sleeve from the RetroConstruction drill guide set (Arthrex), with direct arthroscopic visualization, to prevent the ACL TightRope RT/BTB button from over-running and flipping outside the joint. The key points of this method are as follows: First, the soft tissue around the guide pin used to create the femoral tunnel is carefully dissected under arthroscopy. Second, the graft is gently advanced into the femoral socket until the button is nearly entering the guide pin's hole. Third, the blue passing suture from the iliotibial band portal is guided into the 2.4-mm guide pin sleeve, and the sleeve's tip is then advanced into the joint. Next, the graft is pulled upward until the button contacts the tip of the sleeve. Finally, the tibial-side strands of the graft are pulled distally so that the button seats just above the lateral femoral cortex. This technique can help facilitate the use of all adjustable-loop devices.