International Orthopaedics

, Volume 37, Issue 2, pp 253–269 | Cite as

Medial portal technique for single-bundle anatomical Anterior Cruciate Ligament (ACL) reconstruction

  • Charles H. BrownJr.
  • Tim SpaldingEmail author
  • Curtis Robb
Original Paper


The aim of the paper is to describe the medial portal technique for anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Placement of an ACL graft within the anatomical femoral and tibial attachment sites is critical to the success and clinical outcome of ACL reconstruction. Non-anatomical ACL graft placement is the most common technical error leading to recurrent instability following ACL reconstruction. ACL reconstruction has commonly been performed using a transtibial tunnel technique in which the ACL femoral tunnel is drilled through a tibial tunnel positioned in the posterior half of the native ACL tibial attachment site. ACL reconstruction performed using a transtibial tunnel technique often results in a vertical ACL graft, which may fail to control the combined motions of anterior tibial translation and internal tibial rotation which occur during the pivot-shift phenomenon. The inability of a vertically oriented ACL graft to control these combined motions may result in the patient experiencing continued symptoms of instability due to the pivot-shift phenomenon. The medial portal technique in which the ACL femoral tunnel is drilled through an anteromedial or accessory anteromedial portal allows consistent anatomical ACL tunnel placement. This paper describes the advantages of the medial portal technique, indications for the technique, patient positioning, proper portal placement, anatomical femoral and tibial tunnel placement, graft tensioning and fixation.


Anterior Cruciate Ligament Anterior Cruciate Ligament Reconstruction Femoral Tunnel Tibial Tunnel Intercondylar Notch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Charles H. BrownJr.
    • 1
  • Tim Spalding
    • 2
    Email author
  • Curtis Robb
    • 2
  1. 1.Abu DhabiUnited Arab Emirates
  2. 2.University Hospital Coventry and Warwickshire NHS TrustCoventryUK

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