Chronic Anterior Cruciate Ligament Tear: Single-Bundle ACL Reconstruction: Anteromedial Portal Versus Transfemoral Outside-In Versus Transtibial Drilling Technique

  • Joan Carles MonllauEmail author
  • Xavier Pelfort
  • Pablo Eduardo Gelber
  • Marc Tey
  • Juan Erquicia
  • Vicente Sanchis-Alfonso


Surgical procedures for reconstruction of a torn anterior cruciate ligament (ACL) have changed considerably over the last 30 years. They have evolved from open surgery to advanced all-inside endoscopic techniques. Arthroscopic transtibial ACL reconstructions have been largely used in recent decades. However, a trend toward more anatomic ACL reconstructions has started in recent years due to the high rates of persistent rotatory instability observed after vertically oriented graft. Placing a single femoral tunnel at the center of the anatomic insertions of the ACL may restore the rotational stability of the knee as well as a double-bundle technique. A thorough knowledge of the anatomical attachment sites of the ACL is required for precise anatomic ACL reconstruction.

This chapter focuses on the advantages as well as disadvantages of single-bundle ACL reconstruction when using either the transtibial or anatomic approach. The author’s preferred method and rationale for anatomic single-bundle ACL reconstruction are also presented.


Anterior Cruciate Ligament Anterior Cruciate Ligament Reconstruction Femoral Tunnel Tibial Tunnel Tunnel Length 
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.

Supplementary material

Video 2

ACL reconstruction. The surgical technique (MP4 424462 kb)


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Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Joan Carles Monllau
    • 1
    • 2
    Email author
  • Xavier Pelfort
    • 3
    • 2
  • Pablo Eduardo Gelber
    • 3
    • 2
  • Marc Tey
    • 3
    • 2
  • Juan Erquicia
    • 3
    • 2
  • Vicente Sanchis-Alfonso
    • 4
    • 5
  1. 1.Department of Orthopedic Surgery and TraumatologyHospital de la Sta Creu i Sant PauBarcelonaSpain
  2. 2.ICATME (Catalan Institute of Traumatology and Sports Medicine)Hospital Universitari Dexeus. Universitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Department of Orthopedic Surgery and TraumatologyHospital del Mar. Universitat Autònoma de BarcelonaBarcelonaSpain
  4. 4.Department of Orthopaedic SurgeryHospital Arnau de VilanovaValenciaSpain
  5. 5.Hospital 9 de OctubreValenciaSpain

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