Orthopedics & Orthopedic Surgery
Area of Focus: Arthroscopy and Sports Medicine
We present a double-bundle ACL reconstruction that preserves the remnant of the ACL. First, harvest and split an autogenous quadriceps tendon into two bundles. Then make three unique portals: high anterolateral, low anteromedial, and accessory anteromedial. Next, make two femoral sockets and one tibial tunnel, positioned within the boundaries of the native ACL tibial footprint. To minimize injury to the ACL remnant, advance the reamer carefully: just before perforation, set the rotational direction to counterclockwise. Next, make an anteromedial (AM) femoral socket on the proximal cortex of the notch (at about 1:30 oclock) through the tibial tunnel; make a posterolateral (PL) femoral socket at the crossing point of the long axis of the ACL femoral footprint. Draw a vertical line through the contact point between the femoral condyle and the tibial plateau. Set the headed reamer to counterclockwise to preserve the ACL remnant. To pass the graft, advance it alternately through the tibial tunnel and engage both bundles to each femoral socket, respectively. Position the bone plug sagittally within the tibial tunnel. To fix the bundles at different angles, perform graft tensioning and fixation sequentially. Begin femoral fixation of the PL bundle through the accessory anteromedial portal with the knee in 90 flexion. After tensioning, secure the distal bone plug with the knee in 10 flexion. Apply tension again. Start femoral fixation of the AM bundle with the knee in 90 flexion for easy engagement, and then switch to 70 flexion to finish the fixation.