Single-bundle anterior cruciate ligament reconstruction using the medial portal technique

Complete anterior cruciate ligament (ACL) ruptures can lead to recurrent knee instability, meniscal tears, and articular cartilage degeneration. ACL reconstruction typically has been performed using a single-bundle reconstruction technique that attempts to recreate the normal biomechanical properties of the native ACL. A critical review of the literature reveals that the success rates of single-bundle ACL reconstruction vary between 69% and 95%. The variability of the results may be attributed to the different techniques and styles of the individual surgeon, as there is variability in operative technique, fixation method, graft choice, and rehabilitation protocol. Our technique uses the medial portal technique and intraoperative radiographic analysis to more accurately recreate the anatomic insertion sites of the ACL femoral and tibial tunnels, respectively. Advantages of using the medial portal technique include the following: (1) femoral tunnel and tibial tunnels are placed independently of each other; (2) femoral tunnel is placed more anatomically on the ACL femoral insertion; (3) allows for easy preservation of any remaining ACL fibers (augmentation); and (4) tunnel placement is independent of graft type, fixation devices, or tunnel guides. We present our current technique for anatomic arthroscopic ACL reconstruction using a single-bundle graft.