ACL Reconstruction–Tunnel Placement is Critical for Success!

The goal of anterior cruciate ligament reconstruction (ACLR) is to allow patients to return to their previous level of activity with a low rate of re-injury. To meet this goal, every ACL surgeon should strive to restore the native anatomy and kinematics of the knee. Although surgical techniques for ACLR have evolved, rates of ACL re-injury remain high, especially in young, active patients. While some of these reinjures may be unavoidable, many factors remain under the control of the surgeon. Despite all such factors contributing to a successful outcome, improper or non-anatomic tunnel placement remains the most common reported reason for technical failure. Proper knowledge and recreation of the insertional site anatomy of the ACL, on both the femur and tibia, allows surgeons to restore the patient's native anatomy and function. We present our surgical technique and rationale for placement of our ACL femoral and tibial tunnels which we have found easily reproducible and technically straightforward.