Table 2.

Pearls and Pitfalls

	Pearls	Pitfalls
Tibial bone hole	The surgeon should overdrill only the tibial cortex.	Aggressive drilling may lead to further metaphyseal bone loss or even damage to the articular surface.
Screw placement	Setting the ACL femoral guide at 115° to 120° will help position the guide pin parallel to the articular surface.	Improper ACL jig angulation will result in suboptimal screw placement, resulting in the loss of the “rafter” effect.
	Arthroscopic inspection after guidewire positioning is advised.	Doing so will prevent inadvertent intra-articular positioning of the screw.
Fracture evaluation	The surgeon should evaluate the cortical bone envelope integrity on a computed tomography scan.	Poor bone quality or excessive metaphyseal impaction will result in a weak construct.
	The coronary ligament between the capsule and meniscus may be divided to mobilize the meniscus and visualize the full extent of the fracture.	Inappropriate visualization may underestimate the full fracture extent.
Bone graft	Bone graft placed through the tibial cortical window will help support the articular cartilage reduction.	Graft-site morbidity (autologous graft) and/or increased cost to the patient (allograft) can occur.

ACL, anterior cruciate ligament.