Fig. 1.

Transtibial tunnel technique. a The femoral guide pin is drilled using an ACL femoral offset aimer inserted through a tibial tunnel positioned in the posterior half of the ACL tibial attachment site. b An ACL femoral tunnel drilled through a posteriorly positioned tibial tunnel often results in the ACL femoral tunnel being positioned high relative to the native ACL femoral attachment site. c An ACL graft positioned in a posterior tibial and high femoral tunnel often results in a non-anatomical “vertical” ACL graft. d An example of ACL reconstruction using a transtibial technique