Modified endoscopic anterior cruciate ligament reconstruction: Technique and rationale

Compared with a two-incision approach, endoscopic anterior cruciate ligament reconstruction is often perceived as being more technically demanding and fraught with potential complications. However, technical problems are most often related to constraints imposed by addressing the femoral side of the reconstruction through the tibial tunnel. In our modified technique, the use of an accessory, anterior medial portal and hyperflexed positioning of the knee allows the femoral interference screw and tunnel to be reliably placed in a parallel orientation. This minimizes problems with femoral tunnel malposition, interference screw-tunnel divergence, and significant 'blow-out' of the femoral tunnel posterior wall. A steep tibial tunnel angle, coupled with drilling the femoral tunnel completely to the outer cortical wall, will avoid mismatches in graft-tunnel lengths. The reported modified technique offers a simpler, reproducible approach to endoscopic anterior cruciate ligament reconstruction.