Anatomic double-bundle ACL reconstruction using a bone–patellar tendon–bone autograft: a technical note

This article describes an original arthroscopic double-bundle anterior cruciate ligament (ACL) reconstruction technique using a bone–patellar tendon–bone autograft. A rectangular patellar bone block, with a double strand patellar tendon, and a double tibial bone block is harvested. The femoral anteromedial tunnel is made using an all-inside technique by the anteromedial portal. The femoral posterolateral (PL) tunnel is created with an outside-in technique, with a 30° divergence between both tunnels. A single tibial tunnel is drilled, the graft is then passed through the tibial tunnel, and the bundles are separately tensioned and fixed with three bioabsorbable interference screws. The femoral AM bone block is fixed by the anteromedial portal, the tibial bone block is then fixed in an oblique manner in order to mimic the ACL orientation with the knee at 30° of flexion. The femoral PL bone block is fixed at the end with the knee in full extension.