Anatomic Anterior Cruciate Ligament Reconstruction Integrating the Outside-In and Transtibial Techniques

In anterior cruciate ligament reconstruction, femoral tunnel positioning critically influences postoperative outcomes. Current techniques-transtibial, trans-portal, and outside-in-each present unique trade-offs between anatomic accuracy, technical complexity, and graft compatibility. This study describes a hybrid technique combining the outside-in and transtibial approaches to optimize femoral tunnel placement. The proposed method simplifies surgical workflow, eliminates the need for hyperflexion or specialized instrumentation, achieves anatomic tunnel positioning, and reduces graft bending angles. Clinical advantages include enhanced graft adaptability, reduced risk of posterior wall fractures, and improved rotational stability.