However, the resulting ACL femoral tunnel is often positioned too high and deep in the intercondylar notch, outside of the native ACL femoral attachment site (Fig.
#PORTAL BUNDLE NOT IN DEFAULT LOCATION FULL#
In the transtibial technique, positioning the ACL tibial tunnel in the posterior half of the ACL tibial attachment site is dictated by the need for the arthroscopic drill bit to reach the region of the ACL femoral attachment site and the desire that the ACL graft avoid impingement against the roof of the intercondylar notch when the knee is in full extension. ACL reconstruction has been commonly performed using a transtibial technique in which the ACL femoral tunnel is drilled through a tibial tunnel positioned in the posterior half of the native ACL tibial attachment site.
Clinical studies have demonstrated that non-anatomical ACL graft placement is the most common technical error leading to recurrent instability following ACL reconstruction. Anatomical ACL graft placement is defined as positioning the ACL femoral and tibial bone tunnels at the centre of the native ACL femoral and tibial attachment sites. This paper describes the advantages of the medial portal technique, indications for the technique, patient positioning, proper portal placement, anatomical femoral and tibial tunnel placement, graft tensioning and fixation.Īnatomical placement of an anterior cruciate ligament (ACL) graft is considered critical to the success and clinical outcome of ACL reconstruction. The medial portal technique in which the ACL femoral tunnel is drilled through an anteromedial or accessory anteromedial portal allows consistent anatomical ACL tunnel placement. The inability of a vertically oriented ACL graft to control these combined motions may result in the patient experiencing continued symptoms of instability due to the pivot-shift phenomenon. ACL reconstruction performed using a transtibial tunnel technique often results in a vertical ACL graft, which may fail to control the combined motions of anterior tibial translation and internal tibial rotation which occur during the pivot-shift phenomenon. ACL reconstruction has commonly been performed using a transtibial tunnel technique in which the ACL femoral tunnel is drilled through a tibial tunnel positioned in the posterior half of the native ACL tibial attachment site. Non-anatomical ACL graft placement is the most common technical error leading to recurrent instability following ACL reconstruction. Placement of an ACL graft within the anatomical femoral and tibial attachment sites is critical to the success and clinical outcome of ACL reconstruction.
The aim of the paper is to describe the medial portal technique for anatomical single-bundle anterior cruciate ligament (ACL) reconstruction.
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