Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

Figure 2 Algorithm for anterior cruciate ligament reconstruction with anteromedial portal femoral drilling and distal femoral hardware. Preoperative planning should guide femoral tunnel trajectory and size. Each step of femoral tunnel preparation may be performed under fluoroscopic guidance to avoid contact with existing hardware. Hardware obstruction is most likely to occur during Endobutton drilling. ACL: Anterior cruciate ligament.