Independent drilling of tibial and femoral tunnels in anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) reconstruction can be optimized when single-bundle grafts are centered within the native ligament's tibial and femoral insertions. An understanding of ACL anatomy, including surgical landmarks for tunnel placement, is critical to accomplish this task. The best method for placing the femoral tunnel requires the independent, rather than a transtibial, drilling of the femoral tunnel. A good option for drilling the femoral tunnel is to drill through an anteromedial portal, but this method is challenging because it requires a high angle of knee flexion and visualization of the femoral insertion is limited during drilling. This review provides a rationale for independent tunnel drilling in ACL reconstruction, a method for identifying the insertional anatomy of the ACL, and a method for drilling the femoral tunnel through the anteromedial portal.