Fig 3.

An arthroscope placed in the anterolateral portal on the patient's left knee is used to visualize the femoral footprint of the ACL. The anteromedial portal is used as a working portal to facilitate use of the various arthroscopic instruments including shavers, electrocautery, and burr. After soft tissue is cleared using an arthroscopic shaver and radiofrequency device, the LIR and the LBR can be identified. The LBR marks the separation between the anteromedial and posterolateral bundles of the ACL. The LIR, also known as resident's ridge, is more consistently identified arthroscopically, and this ridge represents the anterior margin of the AM and PL femoral bundles. An arthroscopic burr is used to perform a focal notchplasty to restore the anatomic shape of the intercondylar notch, which helps facilitate graft passage and prevents graft impingement, thereby ensuring full knee range of motion after reconstruction. (ACL, anterior cruciate ligament; AM, anteromedial; LBR, lateral bifurcate ridge; LIR, lateral intercondylar ridge; PL, posterolateral.)