Practical considerations in anterior cruciate ligament replacement surgery

The endoscopic method of anterior cruciate ligament (ACL) reconstruction us ing a patellar tendon graft that is secured with interference screws is a c ommonly performed procedure. It has many potential pitfalls, the majority o f which are secondary to technical errors. Prevention of errors starts with a full knowledge of normal ACL anatomy and any discrepancies with the size and shape of the graft substitute. Accurate tibial and femoral tunnel plac ement is essential and involves using consistent intra-articular landmarks and achieving specific radiographic criteria. Accurate tunnel placement min imizes graft excursion and impingement against the roof of the intercondyla r notch. This will result in maximum knee stability and motion. Much has be en written about the principles of graft-tunnel mismatch and interference s crew-bone plug divergence. The clinical implications of these potential sou rces of error remain somewhat controversial and are discussed in this artic le.