Rectangular Tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft to Mimic Natural Fiber Arrangement

We describe our current technique of anatomic, double-bundle (DB), rectangular tunnel anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft. This technique mimics the natural, or anatomic, arrangement of the native ACL fibers. This technique has the following advantages: (1) creation of a DB ACL reconstruction with a single BPTB graft; (2) maximization of graft-tunnel contact area; (3) containment of the tunnel apertures within the anatomic ACL attachment footprint; (4) rotational control of the graft within the tunnels during and after fixation, and (5) preservation of notch anatomy.