The Anteromedial Portal for Anterior Cruciate Ligament Reconstruction

(A) View of left knee in operating position. The arthroscope is in the anteromedial portal, and the probe is in the accessory medial portal. (B) Arthroscopic image corresponding with previously described situation. Using this approach, with 2 medial portals, allows for visualization of the femoral ACL insertion and simultaneous instrumentation. (C) Arthroscopic view of femoral ACL insertion site through anterolateral portal. (PCL, posterior cruciate ligament.)

Arthroscopic anteromedial portal view of left knee in 90° of flexion. The femoral anteromedial (AM) and posterolateral (PL) tunnels have already been drilled. An 8-mm drill is placed through the accessory medial portal near the most posterior border of the ACL insertion site. This image shows that there is still room between the drill and the medial femoral condyle to allow for safe drilling.

Arthroscopic view of 2 right knees in 90° of flexion. (A) This patient has a large notch, measuring 19 mm in width. Performing ACL reconstruction in a patient with a large notch is less difficult because the surgeon has good visualization and sufficient room for instrumentation. (B) This patient has a small notch, measuring only 11 mm. Performing ACL reconstruction in a patient with a small notch can present a challenge. Drilling a smaller-diameter tunnel or using a flexible guidewire and cannulated drill might offer a solution.