Rectangular Tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction with Bone–Patellar Tendon–Bone Graft to Mimic Natural Fiber Arrangement

We describe our current technique of anatomic, double-bundle (DB), rectangular tunnel anterior cruciate ligament (ACL) reconstruction with bone–patellar tendon–bone (BPTB) graft. This technique mimics the natural, or anatomic, arrangement of the native ACL fibers. This technique has the following advantages: (1) creation of a DB ACL reconstruction with a single BPTB graft; (2) maximization of graft–tunnel contact area; (3) containment of the tunnel apertures within the anatomic ACL attachment footprint; (4) rotational control of the graft within the tunnels during and after fixation; and (5) preservation of notch anatomy.