Accessory Anteromedial Portal for Anatomic Femoral Tunnel Placement in ACL Reconstruction: A Technical Short Communication

Abstract

Anterior cruciate ligament (ACL) reconstruction success is critically dependent on accurate anatomic femoral tunnel placement. Malpositioned femoral tunnels remain a leading cause of residual rotational instability, graft failure, and revision surgery.¹,² The traditional transtibial technique often results in a more vertical femoral tunnel, compromising restoration of native ACL biomechanics.³ The standard anteromedial (AM) portal improves access but may still limit trajectory, particularly in smaller knees or when aiming for the true low–deep native footprint.