Anatomic Transtibial Anterior Cruciate Ligament Reconstruction

Although anterior cruciate ligament (ACL) reconstruction remains one of the most successful orthopedic operations, it has become increasingly clear over the past decade that more anatomic reconstructions result in better knee function when compared with less anatomic reconstructions. This has led to increased scrutiny of the most common transtibial technique and the limitations imparted by constraints of drilling the femoral tunnel through the tibial tunnel. Recently, these limitations have led many authors to suggest that alternative approaches should be used instead. Despite this recent scrutiny, a transtibial technique remains the most widely used method of reconstructing the ACL. This article describes modifications to the traditional transtibial technique to allow reproducible anatomic ACL reconstruction.