Surgical Techniques of ACL Reconstruction, A. AM Portal Technique

By increasingly recognized importance of femoral tunnel position on restoration of native knee kinematics, use of the anteromedial portal (AMP) for establishment of the femoral tunnel is growing interest. The AMP technique is meant to allow for more anatomic femoral tunnel position. To perform easily, appropriate portal formation is the key to the AMP technique. To avoid crowding and jamming of instrument through the AM and additional anteromedial (AAM) portal, it is recommended to make the portals at least 1.5 cm space. The bony anatomy of the lateral femoral condyle is helpful in locating the boundaries of native ACL. Femoral tunnel would be made by using flexible guide and with hyperflexed knee position. Slightly medial positioned tibial tunnel in the native ACL footprint can reduce the risk of graft impingement. After graft passage, the endobutton CL is flipped on the lateral femoral cortex. Before final securing, the position of button should be checked under C-arm fluoroscopy. Finally, the tibial side of graft is secured with bio-absorbable interference screw in full extension with tibiofemoral reduction force. Despite there are the technical challenges associated with AMP technique, complications can be avoided with understanding of the potential pitfalls and technical principles.