Anatomic fixation in double-bundle anterior cruciate ligament reconstruction

Conventional anterior cruciate ligament reconstruction techniques usually have focused on the restoration of the anteromedial bundle while giving limited attention to the posterolateral bundle. In past years, different surgical techniques addressing both the anteromedial and posterolateral bundle were described. Most of these techniques, however, have used an indirect extra-anatomical fixation technique. Concerns may arise regarding delayed biological incorporation and tunnel enlargement in extra-anatomical fixation techniques by graft-tunnel motion, windshield wipering, and suture stretch-out. Therefore, we present a novel arthroscopic technique that not only reapproximates the native footprints of both the anteromedial and the posterolateral bundle but also allows an anatomic fixation of each bundle close to the joint surface.