Bicruciate Knee Ligament Reconstruction Using 4 All-Anterior Arthroscopic Portals

The use of an accessory posteromedial portal for posterior cruciate ligament reconstruction in bicruciate knee ligament reconstruction has often been described. However, the use of a posteromedial portal can be time consuming and has some inherent risks including injury to the saphenous vein or nerve. We describe our bicruciate knee ligament reconstruction using 4 exclusively anterior portals including a high anteromedial, high anterolateral, low anteromedial, and low anterolateral portals. Arthroscopy is performed using a combination of 30° and 70° arthroscopes. Fluoroscopic assistance is used in conjunction with a 70° arthroscope for the creation of the posterior cruciate ligament tibial tunnel.