Chronic anterior cruciate ligament tear: Single-bundle ACL reconstruction: Anteromedial portal versus transfemoral outside-in versus transtibial drilling technique

Abstract

A thorough knowledge of the complex anatomy of the anterior cruciate ligament (ACL) and particularly its anatomical attachment sites is crucial to the success of an anatomic ACL reconstruction. The in fl uence of ACL tunnel placement on the kinematics of the knee has been widely demonstrated [ 31, 37, 41, 45, 48, 50 ]. Misplacement of the femoral tunnel is one of the most common surgical problems that can lead to less than satisfactory outcomes. The femoral tunnel can be drilled in two different directions. The double- incision technique runs from the outside to the inside of the joint. It requires an additional small approach on the lateral aspect of the knee. It used to be more commonly performed, mainly in the 1980s. On the other hand, the single- incision technique starts the femoral tunnel from inside of the joint. This inside-out drilling technique may be performed either with the drill through the previously established tibial tunnel (transtibial technique) or through an accessory medial portal (anteromedial portal technique) [ 3, 26 ]. The superiority of any of these three options is still controversial and somewhat depends on surgeon preference.