Table 2.

Advantages and Disadvantages

Technical Aspect	Advantages	Neutral	Disadvantages
Flat “ribbon-like” graft	Recreates native fiber arrangement with either a quadriceps tendon or a hamstring graft.	No difference in graft size (cross-sectional area).	Learning curve for graft preparation.
Rectangular femoral tunnel	Recreates anatomic ACL origin. Reduces the distance for blood vessel ingrowth.	Guidewire location is the same.	More surgical steps in tunnel preparation.
C-shaped tibial tunnel	Recreates anatomic “C”-shaped insertion. Preserves the anterior tibial insertion of the lateral meniscus. Reduces the distance for blood vessel ingrowth.	–	More steps in tunnel preparation.
Graft insertion	Graft orientation during insertion is achieved with simply extending the knee.	–	Exact graft preparation is required to avoid problems with insertion due to high frictional resistance.

ACL, anterior cruciate ligament.