Anatomic single-bundle ACL reconstruction

A critical evaluation of anterior cruciate ligament (ACL) reconstruction techniques has revealed that single-bundle grafts placed by conventional transtibial drilling do not provide adequate restraint to translational and rotatory forces. In some knees, this will affect function and possibly contribute to chondral injuries. The method of 2-bundle ACL reconstruction has evolved partly to address these concerns with the premise that greater rotational stability will be provided by 2-bundle grafts. Although the question of what constitutes rotational stability is still debated, the methodology of 2-bundle ACL reconstructions has clearly reinforced the need to center grafts within the native ACL insertions. When the principles of anatomic graft placement are combined with an independent drilling method, then single-bundle grafts can restore physiologic laxity to the knee. A thorough knowledge of the ACL insertions is necessary and an independent drilling method using an anteromedial portal is required. The technique for anteromedial portal drilling requires adjustments to permit knee flexion over 125 degrees when drilling. Grafts positioned in this fashion will tend to lengthen in extension and fixation may be accomplished with the knee in close to full extension.