Avoiding pitfalls in anatomic ACL reconstruction

As interest in double-bundle anterior cruciate ligament (ACL) reconstruction grows, we continue to refine our technique to perform the most anatomic reconstruction possible. Our experience has brought to our attention the potential mistakes that should be avoided when performing an anatomic double-bundle ACL reconstruction. These mistakes include (1) failure to visualize the femoral insertion completely, (2) use of the clock face to reference femoral tunnel positioning, (3) nonanatomic tunnel placement leading to graft impingement, (4) mismatching tibial and femoral tunnels, and (5) failure to restore the native tension pattern of the ACL. It is also important to recognize that a double-bundle ACL reconstruction is not necessarily equivalent to an anatomic double-bundle reconstruction. This article reviews potential mistakes in DB ACL reconstruction and describes our way of avoiding them.