Oblique femoral tunnel or oblique graft? A modified anteromedial portal technique to obtain vertical femoral tunnel and oblique graft in anatomic anterior cruciate ligament reconstruction.

In anterior cruciate ligament (ACL) reconstruction, transtibial drilling of the femoral tunnel has been criticized for its vertical and less anatomical tunnel, which accompanied rotational instability of knee. Many authors recommend anteromedial (AM) portal drilling technique, which creates more oblique and anatomic femoral tunnel. However, recent researches show that oblique tunnel is related to risks of too short femoral tunnel, blowout of back wall, and posterolateral structures injury. Is oblique femoral tunnel really essential for anatomic reconstruction? We introduce a modified AM technique, which abandons the oblique tunnel and provides vertical femoral tunnel and oblique graft with anatomic starting point. The fundamental of the new technique is that oblique graft but not oblique tunnel is essential for rotational stability of knee. Thus, it avoids the risks and preserves anatomic reproduction of ACL.