Anatomic Anterior Cruciate Ligament Reconstruction With Eccentric Femoral Footprint Positioning Using a Modified Transtibial Technique

Anatomic placement of tibial and femoral tunnels during anterior cruciate ligament reconstruction is still today a major focus of research in the literature. Eccentric femoral tunnel placement in the center of the anteromedial bundle seems to reduce the risk of revision at mid-term follow-up without significantly compromising knee stability. This technical note presents a modified transtibial drilling technique with femoral tunnel placement in the center of the anteromedial bundle. A medial tibial drilling starting point, bony shaping of the roof of the intercondylar notch, and gentle rotation of the femoral guide are the crucial steps to perform this anatomic anterior cruciate ligament reconstruction technique.