The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction

The purposes of this study were to establish the technique to arthroscopically identify the resident’s ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 × 10 mm was created just behind the ridge. At 3–4-weeks post surgery, three-dimensional computed tomography (3-D CT) was performed to geographically identify the location of the ridge using the socket as a reference. Arthroscopically, a linear ridge running from superior-anterior to inferior-posterior on the lateral notch wall was consistently observed 7–10 mm anterior to the posterior articular cartilage margin of the lateral femoral condyle in all of the patients. The 3-D CT pictures proved the arthroscopically identified ridge to be the resident’s ridge. The resident’s ridge is arthroscopically identifiable after non-mechanical removal of the soft tissues without bony notchplasty. The ridge is a useful landmark for anatomical femoral tunnel drilling in arthroscopic ACL reconstruction.