Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: Challenges and Solutions of Medial Independent Femoral Tunnel Drilling

Background: As the main translational and rotatory stabilizer of knee, anterior cruciate ligament (ACL) plays a critical role in knee biomechanics. Anterior ruptures generally require surgical attention for not only restoration stability but also prevention meniscal chondral injuries. There are countless options both surgeon patient when contemplating graft choice technique ACL reconstruction. However, literature assessing outcomes following various autografts has varied with some studies citing no significant difference clinical patient-reported outcomes, while others showing notable advantage using bone–patellar tendon–bone (BPTB) autograft. In addition, there have been challenges associated femoral tunnel placement an anteromedial portal technique. Indications: this study, we present young female history remote mid-substance tear now presenting worsening instability bucket-handle medial meniscus as sequela incompetent ACL. After extensive discussion regarding treatment options, had decided to proceed intervention BPTB autograft compression bio-absorbable interference screw fixation. Results: Bone–patellar noted lower risk revision compared other options. Discussion: underline importance peritenon handling. We highlight use 70-degree arthroscope improve posterolateral wall visualization during well inspection reamed tibial tunnel. provide commentary solutions management condyle (MFC) articular surface Last, review graft-related postoperative management, rehabilitation protocol.