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Anterior Cruciate Ligament Reconstruction: Single-Bundle Transtibial Technique
Injuries to the anterior cruciate ligament (ACL) are common, typically occurring in association with participation in athletic activities. For active patients, surgical reconstruction of the ACL following injury is recommended in an effort to restore stability and normal knee kinematics that will lead to an improvement in function and a return to an active lifestyle. Various reconstruction techniques and graft options are available for ACL reconstruction, including autograft (bone-patellar tendon-bone [BPTB], quadriceps tendon, and hamstring) and allograft (BPTB, hamstring, anterior and posterior tibialis tendons, and Achilles tendon) tissue. For the past 25 years, patellar tendon autograft reconstruction has been the most commonly used technique secondary to its biomechanical strength, accessibility and ease of graft harvest, bone-to-bone healing, rigid initial interference screw fixation, and its track record of clinical success. This chapter describes the surgical technique for endoscopic ACL reconstruction with BPTB autograft using a single-bundle transtibial approach. This endoscopic technique can be used with patellar tendon autograft tissue, enabling the creation of a femoral tunnel that replicates a portion of both the posterolateral and anteromedial bundles, thereby eliminating both the abnormal Lachman test results and, more importantly, the pivot-shift phenomenon.