Anatomic Transtibial Tunnel Placement Using an Initial 6‐mm Drill Bit for Anterior Cruciate Ligament Reconstruction

Abstract Precise anatomic tunnel placement is essential for restoring native knee biomechanics and minimizing graft failure in anterior cruciate ligament reconstruction. We describe a tibial tunnel drilling technique designed to enhance tunnel placement accuracy, reduce intra‐articular trauma, and preserve native tibial footprint remnants when indicated. Following standard arthroscopic visualization, tibial and femoral tunnel positioning is guided by established anatomic landmarks. Using a tibial guide, a guidewire is initially placed at the intended tibial site. If positioning is suboptimal, a 6‐mm tunnel is created, which provides a controlled working corridor for subsequent guidewire relocation within its margins. This step enables adjustment of tunnel trajectory with high precision. A definitive 10‐mm tunnel is then drilled at the corrected location. Notably, expansion from a 6‐ to 10‐mm tunnel using this technique only increases the overall cross‐sectional tunnel area within the tibia by ~5%, thereby maintaining bone stock and minimizing damage. This technique offers a reproducible method to refine tibial tunnel placement while mitigating the risks associated with repeated drilling and excessive tunnel enlargement.