When I describe the procedure to my friends, they always cringe at the part about drilling holes in the tibia through to the femur. Frankly, I do too. It seems to me the part of the process that dictates more than anything else, how well the knee performs afterwards.
This reminds me of the old salt my father found to help him drill a long hole into the rudder of his cat boat. The procedure called for using a long bit, probably about 1/4" in diameter about 12" into the rudder. The rudder is only about 3/4" thick. A long drill bit can often wander off course, so it takes a very fine sense of feel to steer the bit correctly so it doesn't break out either side of the rudder. My father was a little uncertain about doing it, but this old guy he found, this boat carpenter, held the rudder between his knees, seated the tip of the bit and drilled the hole perfectly, in one smooth stroke. This is how I imagine the surgery works -- it requires a steady hand, a good feel for the proper angles, and an intimate understanding how the knee functions, and needs to function with its new ACL.
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There certainly is an art to this procedure, but the surgeon also relies on a jig to help guide the drilling. Not quite the same as some old salt taking a glance at your leg and going at it with a Makita drill. Not exactly.
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