Functional Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction Using Retrograde Femoral Socket Drilling via a Far Anteromedial Portal Combined with a Conventional Antegrade Tibial Tunnel: A Retrospective Cohort Study

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction remains the accepted standard of care for ACL ruptures in physically active individuals. Various surgical techniques have been developed to achieve anatomic reconstruction and optimize functional outcomes. The aim of this study was to descriptively report the early functional outcomes of anatomic ACL reconstruction performed using retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel, without claiming superiority over alternative techniques. Methods: This single-center, single-arm retrospective cohort study included 33 consecutive male patients with ACL rupture who underwent arthroscopic ACL reconstruction using hamstring tendon autograft between 2021 and 2022 at a tertiary academic medical center. The surgical technique employed retrograde drilling of the femoral socket using a FlipCutter device introduced through a far anteromedial portal; the tibial tunnel was created with a standard outside-in aiming guide. The pre-specified primary outcome was the change in the Tegner–Lysholm score from baseline to 12 months; secondary outcomes were the Modified Cincinnati and International Knee Documentation Committee (IKDC) subjective scores and clinical stability tests. Functional outcomes were assessed preoperatively and at 6 weeks, 3 months, and 12 months postoperatively using repeated-measures testing with the Friedman test and post hoc Wilcoxon signed-rank tests with Bonferroni correction. Reporting followed the STROBE recommendations for observational studies. Results: All 33 patients (100% male) completed the 12-month follow-up. The mean age was 28 years (range: 18–44), and sports-related injuries accounted for 84.8% of cases. Significant improvements were observed in all functional scores from preoperative to 12-month postoperative assessments (p < 0.001). The mean Tegner-Lysholm score improved from 46.8 ± 17.3 preoperatively to 83.7 ± 10.5 at 12 months (mean change +36.9, 95% CI 30.3 to 43.5; matched-pairs effect size r = 0.87). The mean IKDC score increased from 36.3 ± 14.4 to 68.4 ± 15.1 (mean change +32.1, 95% CI 25.3 to 38.9; r = 0.84), and the Cincinnati score improved from 41.3 ± 15.9 to 80.2 ± 10.9 (mean change +38.9, 95% CI 32.6 to 45.2; r = 0.86). All observed mean changes exceeded the minimal clinically important difference (MCID) reported for these instruments in ACL populations. Postoperative stability assessment demonstrated restoration of knee stability in the majority of patients, with 66.7% showing a negative anterior drawer test at final follow-up. Conclusions: Anatomic ACL reconstruction utilizing retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel was associated with satisfactory early functional outcomes in a small, all-male cohort, comparable to those reported for contemporary anatomic ACL reconstruction techniques. Given the retrospective, single-arm design, modest sample size, homogeneous all-male cohort, absence of instrumented laxity or return-to-sport data, and absence of multivariable adjustment, any suggestion of technique-specific advantages should be regarded as hypothesis-generating. Comparative effectiveness against other anatomic techniques remains to be established in prospective, controlled studies with longer follow-up.