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Anterior Cruciate Ligament Reconstruction: Two-Tunnel Technique
The anterior cruciate ligament (ACL) has been shown to play a critical role in the maintenance of knee stability. Leaving an ACL-deficient knee untreated can result in recurrent instability, meniscal pathology, and articular cartilage damage. Despite the fact that ACL injury has become one of the most popular topics of study in orthopaedic sports medicine, significant disagreement exists on the appropriate management of this injury. Despite adherence to strict surgical principles, the inability to predict long-term articular cartilage degeneration after ACL reconstruction (ACLR) has raised questions about the choice of surgical technique, graft choices, fixation, and rehabilitation. In this chapter, we present our preference for ACLR, which is based on a single-bundle reconstruction primarily using a bone–patellar tendon–bone (BTB) autograft. The procedure takes advantage of the medial portal technique (versus transtibial) for femoral tunnel placement. Unique to this technique is its versatility, being appropriate for all autograft and allograft types as well as fixation methods.