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Related Experiment Video

Updated: Jul 24, 2026

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications

Published on: April 30, 2014

Minimally Invasive 2-Incision Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction Using Retrograde

Dylan S Koolmees¹, Joseph D Lamplot¹, Andrew D Nahr¹

¹Campbell Clinic Orthopaedics, University of Tennessee Health Sciences Center, Germantown, Tennessee, U.S.A.

Arthroscopy Techniques

|March 5, 2025

Summary

Graft-tunnel mismatch in anterior cruciate ligament reconstruction can be avoided using a minimally invasive two-incision technique. This method is particularly useful for patients with longer patellar tendons, preventing complications.

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Last Updated: Jul 24, 2026

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Published on: October 20, 2023

Area of Science:

Orthopedic Surgery
Sports Medicine
Biomedical Engineering

Background:

Graft-tunnel mismatch (GTM) is a significant technical challenge in anterior cruciate ligament (ACL) reconstruction using patellar tendon autografts.
Two-incision ACL reconstruction is a recognized technique that can effectively mitigate GTM.
Traditional femoral tunnel drilling in two-incision ACL reconstruction often involves an over-the-top guide via a lateral incision.

Purpose of the Study:

To present a minimally invasive, two-incision technique for femoral tunnel drilling in ACL reconstruction.
To demonstrate how this technique can prevent graft-tunnel mismatch, especially in patients with longer patellar tendons.
To highlight the advantages of modern retrograde reamer guides for percutaneous drilling.

Main Methods:

Utilizing a minimally invasive, two-incision approach for ACL reconstruction.
Employing modern retrograde reamer guides for percutaneous femoral tunnel drilling.
Adapting the technique for patients with longer-than-average patellar tendon lengths.

Main Results:

Successful prevention of graft-tunnel mismatch in the described patient cohort.
Demonstration of a feasible and effective minimally invasive technique for femoral tunnel creation.
Facilitation of ACL reconstruction in patients with anatomical variations (longer patellar tendons).

Conclusions:

A minimally invasive, two-incision femoral tunnel drilling technique offers a viable solution to prevent graft-tunnel mismatch in ACL reconstruction.
This technique is particularly beneficial for patients with longer patellar tendons.
Modern instrumentation allows for percutaneous drilling, enhancing the minimally invasive nature of the procedure.