Table 2.

Pearls, Pitfalls, and Risks

Pearls -Perform the PM portal under transillumination to visualize and avoid iatrogenic injuries to the saphenous vein and nerve -A graft thickness of 6 to 7 mm is considered adequate to avoid overstuffing and allow smooth passage -Place the PCL tibial tunnel drill-guide at the posterior border of the tibial champagne glass deformity but 5 mm more medially to the native PCL to avoid injury of the ALB. -The 2.4-mm tibial guide pin should be inserted carefully to avoid damaging the posterior neurovascular structures -Place a curet over the guide pin inserted from the AM portal to protect the posterior neurovascular structures when drilling the tibial tunnel -The femoral 2.4-mm guide pin is introduced through an accessory inferolateral portal -The graft is inserted from the tibia to the femur, first fixed on the femoral and then secured on the tibial side in full extension and neutral rotation, after applying an anterior drawer. -In case of difficulties related to the killer turn angle at the posterior exit of the tibial tunnel during graft passage, a useful maneuver could be to put the probe in the PM portal and use it as a pulley for the graft, or use the KingFisher though the AM portal, to pull up the sutures, thus reducing the killer angle

Pitfalls and Risks -Risk of iatrogenic injuries to the saphenous vein and nerve when performing the PM portal. -Risk of damage to the posterior neurovascular structures and undesired injury of the ALB, when drilling the tibial tunnel -Difficulties related to the killer turn angle at the posterior exit of the tibial tunnel during graft passage

ALB, anterolateral bundle; AM, anteromedial; PCL, posterior cruciate ligament; PM, posteromedial; PMB, posteromedial bundle.