Endoscopic anterior cruciate ligament reconstruction: modified technique and radiographic review

The original technique for endoscopic anterior cruciate ligament reconstruction has several potential complications because of constraints imposed by working through the tibial tunnel: improper femoral tunnel placement, violation of the femoral tunnel posterior wall, femoral interference screw divergence, graft laceration during screw insertion, and distal tibial bone block protrusion. We performed 100 consecutive endoscopic anterior cruciate ligament reconstructions with bone-tendon-bone autograft using a modified technique that minimizes each of these problems through the use of an accessory medial parapatellar portal. Postoperative radiographic review showed femoral screw divergence in only 9% of cases (average angle, 6.9 degrees), all in the anteroposterior plane. The tibial tunnel was drilled at an average of 66 degrees to the plateau and averaged 52 mm in length. There was no graft damage during screw insertion or protrusion of the bone blocks. We conclude that this modified technique allows simplified, reproducible tunnel and interference screw placement.