Anterior cruciate ligament reconstruction the two-incision technique

Historically, the two-incision technique for anterior cruciate ligament (ACL) reconstruction was the standard of practice. It allows predictable, near-anatomic placement of the femoral tunnel and provides highly reproducible results with few complications. There are several major advantages of the two-incision technique over endoscopic methods. These include consistent femoral tunnel placement, elimination of concern for "blowing out the back wall," elimination of the problem of graft-tunnel mismatch, elimination of the problem of screw divergence, and ease of use for revision ACL reconstruction procedures. The angle of the ACL graft is also more anatomic, matching the angle of the native ACL. In this chapter we present our technique for reconstruction of the ACL using the two-incision approach. Indications for its use are discussed. Advantages and disadvantages of the two-incision method compared with the all-endoscopic approach are reviewed.